Chinese Medical Journals Research Articles

Analyzing the Utilization Ratio of the Medical Records in Medical Papers

AbstractObjectives. To analyze the ratio of utilization of medical records used in writing medical papers for the medical staff. Methods. Papers published in the Chinese Medical Series Journals and the Core Journals are subjected to statistical analysis by using the method of proportion in the statistical description, so as to analyze the utilization of clinical articles, case reports and so on. Results. The clinical articles written utilizing medical records accounted for 35.45% in the Chinese Medical Series Journals and 55.00% in the Core Journals. The figure is a little low for a comprehensive tertiary hospital. Conclusions. Increasing the utilization of medical records is a prerequisite in papers, as it enhances their number and quality in a stable manner. It is an important problem which needs attention and study.

Acupuncture for glaucoma.

Glaucoma is a multifactorial optic neuropathy characterized by an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding atrophy of the optic nerve. Although many treatments are available to manage glaucoma, glaucoma is a chronic condition. Some patients may seek complementary or alternative medicine approaches such as acupuncture to supplement their regular treatment. The underlying plausibility of acupuncture is that disorders related to the flow of Chi (the traditional Chinese concept translated as vital force or energy) can be prevented or treated by stimulating relevant points on the body surface. The objective of this review was to assess the effectiveness and safety of acupuncture in people with glaucoma. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2013), EMBASE (January 1980 to January 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2013), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to January 2013), ZETOC (January 1993 to January 2013), Allied and Complementary Medicine Database (AMED) (January 1985 to January 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en) and the National Center for Complementary and Alternative Medicine web site (NCCAM) (http://nccam.nih.gov). We did not use any language or date restrictions in the search for trials. We last searched the electronic databases on 8 January 2013 with the exception of NCCAM which was last searched on 14 July 2010. We also handsearched Chinese medical journals at Peking Union Medical College Library in April 2007.We searched the Chinese Acupuncture Trials Register, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), and the Chinese Biological Database (CBM) for the original review; we did not search these databases for the 2013 review update. We included randomized controlled trials (RCTs) in which one arm of the study involved acupuncture treatment. Two authors independently evaluated the search results and then full text articles against the eligibility criteria. We resolved discrepancies by discussion. We included one completed and one ongoing trial, and recorded seven trials awaiting assessment for eligibility. These seven trials were written in Chinese and were identified from a systematic review on the same topic published in a Chinese journal. The completed trial compared auricular acupressure-a nonstandard acupuncture technique-with the sham procedure for glaucoma. This trial is rated at high risk of bias for masking of outcome assessors, unclear risk of bias for selective outcome reporting, and low risk of bias for other domains. The difference in intraocular pressure (measured in mm Hg) in the acupressure group was significantly less than that in the sham group at four weeks (-3.70, 95% confidence interval [CI] -7.11 to -0.29 for the right eye; -4.90, 95% CI -8.08 to -1.72 for the left eye), but was not statistically different at any other follow-up time points, including the longest follow-up time at eight weeks. No statistically significant difference in visual acuity was noted at any follow-up time points. The ongoing trial was registered with the International Clinical Trials Registry Platform (ICTRP) of the World Health Organization. To date this trial has not recruited any participants. At this time, it is impossible to draw reliable conclusions from available data to support the use of acupuncture for the treatment of glaucoma. Because of ethical considerations, RCTs comparing acupuncture alone with standard glaucoma treatment or placebo are unlikely to be justified in countries where the standard of care has already been established. Because most glaucoma patients currently cared for by ophthalmologists do not use nontraditional therapy, clinical practice decisions will have to be based on physician judgments and patient preferences, given this lack of data in the literature. Inclusion of the seven Chinese trials in future updates of this review may change our conclusions.

Professor da-yi hu.

Professor Da-Yi Hu (Figure 1) was born in Henan province of central China, in 1946. He graduated from the Beijing Medical School (now Peking University Health Science Center) in 1970 and furthered his education both at SUNY-Oswego and University of Illinois from 1985 to 1987. Professor Hu has been a pioneer in the field of radio-frequency ablation technology in the treatment of tachyarrhythmia. Since 1980, he had actively shared his work with more than 160 hospitals in China along with several hospitals in India, Vietnam and Japan. He has specialized in preventive cardiology, electrophysiology, pacemaker implantation and interventional therapy of coronary artery disease. He also focuses on the treatment and prevention of hypertension, coronary heart disease, heart failure and arrhythmias. He has been recognized with mutiple awards for his outstanding clinical, academic and social service work, such as “National Prize for Progress in Science and Technology” (twice), “Chinese Physicians Award” and “Beijing Advanced Science Workers”, to name a few. Currently, he actively participates in the management and prevention of cardiovascular disease and comprehensive interdisciplinary research at a national level. He is the principal investigator of dozens of clinical trials initiated and conducted in the Chinese Mainland, including the China Heart Survey. He has also served at the Steering Committee in many international clinical trials such as ROCKET, BEAUTIFUL, GARFIELD, SHIFIT, SAVE, ACE, MAGELLAN, SIGNIFY, ALECARDIO, Dal-HEART, TIMI54, etc. Figure 1. Professor Da-Yi Hu, MD, FACC Professor Hu is the Editor-in-Chief of Chinese Journal of Cardiology, the official journal of the Chinese Society of Cardiology, the Associated Editor-in-Chief of the Journal of Geriatric Cardiology, a member of the Board of Directors of the International Society of Cardiovascular Pharmacotherapy (ISCP), an international Board Member of the Journal of Clinical Cardiology, Journal of the American College of Cardiology, European Heart Journal, Nature Cardiovascular Medicine, and many other Chinese and international medical journals. Professor Hu has authored, edited and translated 39 professional books, three of which have been published in the United States. He has published 427 research papers in journals at home and abroad. He also has published hundreds of essays, reviews and comments on medicine, healthcare in Chinese newspapers and magazines. Between 1989 and 2011, 82 postgraduate candidates, 34 doctoral candidates and 19 post-doctoral candidates from three different medical schools have graduated under his supervision, many of whom currently holding prestigious positions around China. Professor Hu has presided more than 20 international conferences and 30 small and medium-sized meetings and events. Professor Hu has made tremendous contributions towards promoting Chinese cardiac pacing and electrophysiology, Chinese preventive cardiology and has been a huge proponent of health education in China. Professor Hu is currently the director of the Intervention Center at Peking University People’s Hospital, the Dean of Clinical Research Institute at Fudan University in Shanghai, President of the Committee of Cardio-Cerebral-Vascular Diseases of Geriatric Society of China, President of Cardiovascular Rehabilitation Branch-Chinese Association of Rehabilitation Medicine (CRB-CARM). He is the past president of the Chinese Society of Cardiology, the first president of the Chinese College of Cardiovascular Physicians (CCCP). He is an academician of The International Academy of Sciences for Europe and Asia (IASEA). Professor Hu is now also served as a consulting cardiologist at the United Family Healthcare, an international standard healthcare organization in China.

1084 Urological papers and issues arising from the early years of the Chinese medical journal

1084 Urological papers and issues arising from the early years of the Chinese medical journal

Acupuncture-Associated Pneumothorax

This article reports on a case and reviews some articles on acupuncture- induced pneumothorax published in Chinese and English medical journals since 1980. A 35-year-old man presented with left chest pain and dyspnea after receiving acupuncture. The patient was later diagnosed with a 12% pneumothorax of the left lung. He was observed in an emergency room for 24 hours while being treated with oxygen, a painkiller, antibiotics, and bedrest. A follow-up computed tomography scan of his chest 1 week later showed complete resolution of the pneumothorax. CASE ANALYSIS AND DISCUSSION: Details of the case are analyzed. A general review of the incidence, causes, symptoms, and outcomes of acupuncture induced pneumothorax is presented. In addition, improved needling methods including needling depth and angle, together with corresponding precautions are also discussed. Pneumothorax caused by acupuncture therapy uncommon, but the consequences can be serious. It is important for practitioners to have adequate knowledge so they can implement better prevention of acupuncture-induced pneumothorax.

Investigations of the use of Medical Terms of Chinese Medical Journal

Aim to investigate the use of medical terms in Chinese Medical Journal.Methods Through the Chinese Medical Association area of WANGFANG datebase,we selected the nonstandard nomenclature of 100 medical terms as keywords,all the fields as Search Options and Journal of Chinese Medical Association as Journal categories to trace articles in periodicals from 2006 to 2010.Results Some journals still use nonstandard nomenclature,79％ of the 100 nonstandard nomenclature were used.Standard nomenclature and nonstandard nomenclature were used interchangeably in 80％ of the top 10 medical terms.Conclusions It is not optimistic about the use of Standard nomenclature in Chinese Medical Journal.Great attention shall be paid to the standard use of medical terms.The article analyzed the reasons about the use of nonstandard nomenclature and proposed measures to change the status. Key words: Medical Terminology; normalization; ZhongHua series of magazines; countermeasure

Meta-analysis on impact of Danshen on liver regeneration in rats

To assess the effect of Danshen on liver regeneration capacity of carbon tetrachloride-induced liver injury rats. Computer retrieval of data from CJFD, CBM, Chinese science & technology journal full-text database and Chinese medical association digital journals, and such foreign databases as PubMed, EMBASE and SCI was included in the randomized controlled trials (RCT) of rat liver injury induced by carbon tetrachloride,with the search as at May 2012. A Meta analysis was made using Rev-Man 5.1 software. Using the GRADE system to addess five outcomes in stuay. Two hundred and fourteen rats got involved in seven randomized trials. Meta analysis showed there were statistical differences between the Danshen group and the control group in alanine aminotransferase (ALT), aspartate aminotransferase (AST), superoxide dismutase (SOD), tumor necrosis factor-alpha (TNF-alpha) and hyaluronic acid (HA) after rat liver injury induced by carbon tetrachloride. When we used system to each outcome, because of serious limitations and indirect, they are all very low quality. Danshen shows certain promoting effect to liver regeneration in carbon tetrachloride-induced liver injury rats.

Bibliometric analysis of Chinese ophthalmological papers indexed in SCI database from 2007 to 2011

[Objective] To learn the bibliometric characteristics of Chinese ophthalmological papers indexed in SCI database from 2007 to 2011.[Methods] All the ophthalmological papers published in the source journals indexed in the SCI database from 2007 to 2011 were retrieved.The papers of first authors were manually selected for bibliometric analysis.[Results] The ophthalmological papers published by Chinese scholars as the first author were 478,482,698,791,and 1049 from 2007 to 2011 (total 3498).The five institutions that published papers in the most were Sun Yat-sen University,Capital University of Medical Sciences,Fudan University,Hong Kong Chinese University and Shanghai Jiaotong University.The papers were distributed in 625 journals.The top five journals the papers were published in were Molecular Vision (332),International Journal of Ophthalmology (268),Investigative Ophthalmology & Visual Science (206),Chinese Medical Journal (109),and Graefe′s Archive for Clinical and Experimental Ophthalmology (104).The 3498 papers were cited 12 030 times,3.44 times per paper.The rate of non-cited articles for 5-year,3-year and 2-year periods were 12.55％,24.21％ and 38.43％ respectively.[Conclusion]s Chinese ophthalmological papers indexed in SCI database have gradually increased.Chinese ophthalmological papers mainly originate in the affiliated hospital of universities and colleges.There are four ophthalmologic professional periodicals included in the top five in the quantity of articles. Key words: Journal article; Bibliometrics; Databases, bibliographic

The Emergence of Central Sleep Apnea after Surgical Relief of Nasal Obstruction in Obstructive Sleep Apnea

By the current definition, complex sleep apnea (CompSA) refers to the emergence of central sleep apnea (CSA) during the treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). However, new-onset CSA has been described with use of other treatments for OSA, including tracheostomy, maxillofacial surgery, and mandibular advancement device. We present a patient with CSA beginning after endoscopic sinus and nasal surgery for nasal obstruction in the setting of mild OSA. This case highlights the importance of non-PAP mechanisms in the pathogenesis of CompSA.

Treatment of cholecystitis with Chinese herbal medicines: A systematic review of the literature

To analyze the literature on the use of Chinese herbal medicines for the treatment of cholecystitis. The literature on treatment of cholecystitis with traditional Chinese medicines (TCM) was analyzed based on the principles and methods described by evidence-based medicine (EBM). Eight databases including MEDLINE, EMbase, Cochrane Central (CCTR), four Chinese databases (China Biological Medicine Database, Chinese National Knowledge Infrastructure Database, Database of Chinese Science and Technology Periodicals, Database of Chinese Ministry of Science and Technology) and Chinese Clinical Registry Center, were searched. Full text articles or abstracts concerning TCM treatment of cholecystitis were selected, categorized according to study design, the strength of evidence, the first author's hospital type, and analyzed statistically. A search of the literature published from 1977 through 2009 yielded 1468 articles in Chinese and 9 in other languages; and 93.92% of the articles focused on clinical studies. No article was of level I evidence, and 9.26% were of level II evidence. The literature cited by Science Citation Index (SCI), MEDLINE and core Chinese medical journals accounted for 0.41%, 0.68% and 7.29%, respectively. Typically, the articles featured in case reports of illness, examined from the perspective of EBM, were weak in both quality and evidence level, which inconsistently conflicted with the fact that most of the papers were by authors from Level-3 hospitals, the highest possible level evaluated based on their comprehensive quality and academic authenticity in China. The published literature on TCM treatment of cholecystitis is of low quality and based on low evidence, and cognitive medicine may functions as a useful supplementary framework for the evaluation.

Analysis and management countermeasure on rename of medical journal

The article analyzed the phenomenon of changing names of Chinese medical journal in recent years,together with the influence of this changing,and put forward some relative management measures. Key words: Medical journal; Journal rename; Journal management

Profit or access: which is more important for Chinese medical journals?

The Chinese Medical Association, one of the largest and most influential medical journal publishers in China, signed an exclusive copyright transfer agreement with Beijing Wanfang Data Co. Ltd in 2006, which ended the era of cheap transfer of copyrights from journals to full-text databases. Since then, many journals have chosen the same route to earn more money. However, without generally recognized databases that offer free access to medical abstracts in China, many potential readers are lost. In addition, many Chinese readers do not have adequate literature retrieval skills: more convenient access to journals is therefore far more important than earning immediate profits. Goods in exclusive shops are more expensive than those in ordinary shops. That is why many journals sell exclusive copyrights to databases. However, while obtaining more profits by exclusive copyright transfer, journals may actually lose a large proportion of readers.

Correlation between Download and Citation and Download-citation Deviation Phenomenon for Some Papers in Chinese Medical Journals

The authors collected the numbers of citations and downloads from 2005 to 2009 of papers in five Chinese general ophthalmological journals: Recent Advances in Ophthalmology, Chinese Ophthalmic Research, Ophthalmology in China, Journal of Clinical Ophthalmology and Chinese Journal of Practical Ophthalmology, published in 2005 from the Chinese Academic Journals Full-text Database and the Chinese Citation Database in Chinese National Knowledge Infrastructure (CNKI) to determine the correlation between download and citation and the peak time of download frequency (DF). The citations from 2000 to 2009 of papers published in 2000 were collected to determine the peak time of citation frequency (CF) of medical papers. There is a highly positive correlation between DF and CF (r = 4.91, P = 0.000).

Systematic assessment and meta-analysis of the efficacy and safety of fasudil in the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage

Cerebral vasospasm (CVS) is a frequent and unpredictable complication in patients with subarachnoid hemorrhage (SAH) and often leads to poor outcomes. This study was aimed at evaluating the efficacy and safety of fasudil in the treatment of CVS in patients with SAH. A search was conducted using the full-text database of Chinese scientific journals, the Wanfang Database (January 1999 to November 2010), the Chinese Medical Association Digital Journal Database, PubMed, the Cochrane library, OVID, and EMBase (searching through November 2010). A total of 8 studies met the inclusion criteria. The incidence rates of symptomatic CVS and CVS confirmed by angiography among the patients in the fasudil group were only 48% (odds ratio [OR] = 0.48, 95% confidence interval [CI]: 0.32-0.72, P = 0.0005) and 40% (OR = 0.40, 95% CI: 0.24-0-67, P = 0.0004) respectively of that of the control group. The odds ratios of cerebral infarction for all cases and cerebral infarction for CVS cases in the fasudil group were only 50% (OR = 0.50, 95% CI: 0.34-0.76, P = 0.0009) and 43% (OR = 0.43, 95% CI: 0.26-0.70, P = 0.0008) respectively of that of the control group. Fasudil greatly reduces the occurrence of CVS and cerebral infarction in SAH patients, significantly improves the clinical outcomes of the patients (as assessed by the Glasgow Outcome Scale). Because of the limited number of trials and samples available for analysis, the conclusions from the present study still need to be validated with results from large randomized, controlled clinical trials.

An empirical analysis of overlap publication in Chinese language and English research manuscripts.

BackgroundThere are a number of sound justifications for publishing nearly identical information in Chinese and English medical journals, assuming several conditions are met. Although overlap publication is perceived as undesirable and ethically questionable in Europe and North America, it may serve an important function in some regions where English is not the native tongue. There is no empirical data on the nature and degree of overlap publication in English and Chinese language journals.Methods/Principal FindingsA random sample of 100 English manuscripts from Chinese institutions was selected from PubMed. Key words and institutions were searched in the China National Knowledge Infrastructure, a comprehensive Chinese language research database. Unacknowledged overlap was a priori defined according to International Committee of Medical Journal Editor (ICMJE) guidelines following examination by two individuals. 19% (95% CI 11–27) of English manuscripts from Chinese institutions were found to have substantial overlap with Chinese published work based on full text examination. None of the manuscripts met all of the criteria established by the ICMJE for an acknowledged overlap publication. Individual-level, journal-level, and institutional factors seem to influence overlap publication. Manuscripts associated with an institution outside of China and with more than one institution were significantly less likely to have substantial overlap (p<0.05).Conclusions/SignificanceOverlap publication was common in this context, but instances of standard ICMJE notations to acknowledge this practice were rare. This research did not cite the identified overlap manuscripts with the hope that these empirical data will inform journal policy changes and structural initiatives to promote clearer policies and manuscripts.

Correlation between Download and Citation and Download-citation Deviation Phenomenon for Some Papers in Chinese Medical Journals

The authors collected the numbers of citations and downloads from 2005 to 2009 of papers in five Chinese general ophthalmological journals: Recent Advances in Ophthalmology, Chinese Ophthalmic Research, Ophthalmology in China, Journal of Clinical Ophthalmology and Chinese Journal of Practical Ophthalmology, published in 2005 from the Chinese Academic Journals Full-text Database and the Chinese Citation Database in Chinese National Knowledge Infrastructure (CNKI) to determine the correlation between download and citation and the peak time of download frequency (DF). The citations from 2000 to 2009 of papers published in 2000 were collected to determine the peak time of citation frequency (CF) of medical papers. There is a highly positive correlation between DF and CF ( r = 4.91, P = 0.000).

Influence of journals indexed by Science Citation Index (SCI) on Chinese medical journals based on the data of published articles by Chinese authors from 2000 - 2009

This study was designed to investigate the influence of journals indexed by Science Citation Index (SCI) on Chinese medical journals. Articles on medicine written by Chinese and the journals that published these articles from 2000 to 2009 were searched using Science Citation Index Expanded (SCI-E) database, and the status and variation tendency of the impact factors (IF) of these journals were analyzed. Data of articles on medicine included Chinese Scientific and Technical Paper and Citations Data (CSTPCD) from 2000 to 2008 were searched (the data of 2009 have not been released). The included articles and the time-dependent changing profile were studied. These outcomes were evaluated as the fixed base relative or link relative when compared with the data of 2000 or those of last year, respectively. Geometric mean was used when mean increase was calculated and IF distribution was described with median. Totally 3774 articles from China were published by journals indexed by SCI-E in 2000, and the number of articles published by Chinese authors increased every year. In 2008, 16 714 articles were indexed by SCI-E, 442.87% higher than those of 2000. The increment was 161.54% higher than that of articles published in the journals indexed by CSTPCD (281.33%) during the same period. From 2000 to 2009, the geometric mean of increase in the number of published articles from China in journals indexed by SCI-E was 20.87% but it was 18.21% in CSTPCD. From 2000 to 2009, the median of IF of SCI-E indexed journals that published Chinese medical articles was 1.866, 2.073, 2.390, 2.702, 2.409, 2.496, 2.380, 2.218, 2.280 and 2.331, respectively, and they did not increase or even decreased. The number of the articles indexed by SCI-E increased year by year, much faster than that of CSTPCD. However, it does not necessarily mean the increase in impact.

The Bibliometric Characteristics of Chinese Medical Core Journals

To provide bibliometric evidence for Chinese medical journals to be considered for the evaluation system of core journals, the authors have undertaken a comparative study on bibliometric characteristics between Chinese core journals and common journals (journals not included in A Guide to the Core Journals of China). There are 203 Chinese medical core journals and 440 Chinese common journals. Impact factor, ratio of articles supported with funding sources (foundation), total yearly pages and average article length of core journals are significantly higher than those of common journals in China. Medical editors can take effective measures to improve academic levels and journal impact by considering factors from this study, such as having a proper and short publication cycle, increasing the impact factor, concentrating on articles with foundation support, publishing more high-impact papers, increasing substantive content and publishing more articles with abstracts.

Is automatic CPAP titration as effective as manual CPAP titration in OSAHS patients? A meta-analysis

It is costly and time-consuming to conduct the standard manual titration to identify an effective pressure before continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) patients. Automatic titration is cheaper and more easily available than manual titration. The purpose of this systematic review was to evaluate the effect of automatic titration in identifying a pressure and on the improvement of apnea/hyponea index (AHI) and somnolence, the change of sleep quality, and the acceptance and compliance of CPAP treatment, compared with the manual titration. A systematic search was made of the PubMed, EMBASE, Cochrane Library, SCI, China Academic Journals Full-text Databases, Chinese Biomedical Literature Database, Chinese Scientific Journals Databases and Chinese Medical Association Journals. Randomized controlled trials comparing automatic titration and manual titration were reviewed. Studies were pooled to yield odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). Ten trials involving 849 patients met the inclusion criteria. It is hard to identify a trend in the pressures determined by either automatic or manual titration. Automatic titration can improve the AHI (MD = 0.03/h, 95% CI = -4.48 to 4.53) and Epworth sleepiness scale (SMD = -0.02, 95% CI = -0.34 to 0.31,) as effectively as the manual titration. There is no difference between sleep architecture under automatic titration or manual titration. The acceptance of CPAP treatment (OR = 0.96, 95% CI = 0.60 to 1.55) and the compliance with treatment (MD = -0.04, 95% CI = -0.17 to 0.10) after automatic titration is not different from manual titration. Automatic titration is as effective as standard manual titration in improving AHI, somnolence while maintaining sleep quality similar to the standard method. In addition, automatic titration has the same effect on the acceptance and compliance of CPAP treatment as manual titration. With the potential advantage of time and cost savings, automatic titration was recommended to be applied in identifying a proper pressure for CPAP treatment instead of manual titration in clinical practice.

The Bibliometric Characteristics of Chinese Medical Core Journals

To provide bibliometric evidence for Chinese medical journals to be considered for the evaluation system of core journals, the authors have undertaken a comparative study on bibliometric characteristics between Chinese core journals and common journals (journals not included in A Guide to the Core Journals of China). There are 203 Chinese medical core journals and 440 Chinese common journals. Impact factor, ratio of articles supported with funding sources (foundation), total yearly pages and average article length of core journals are significantly higher than those of common journals in China. Medical editors can take effective measures to improve academic levels and journal impact by considering factors from this study, such as having a proper and short publication cycle, increasing the impact factor, concentrating on articles with foundation support, publishing more high-impact papers, increasing substantive content and publishing more articles with abstracts.