OBJECTIVE:To compare antidiuretic activity of Ootheca Mantidis before and after processing,and to explore the best medicinal part and mechanism of Ootheca Mantidis. METHODS:96 rats were randomly divided into blank group,model group,positive group,Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group,steamed Ootheca Mantidis group, crude product eggs and egg shell groups,processed product eggs and egg shell groups,with 8 rats in each group,12 groups in to-tal. Except blank group,other groups were given adenine 250 mg/kg,ig,for 4 weeks to induce kidney-yang and diuresis model. From third week,Ootheca Mantidis crude drug group and processed Ootheca Mantidis group were all given relevant medicine 0.11 g(crude drug)/ml i.g,and crude product eggs and egg shell groups and processed product eggs and egg shell groups were given rel-evant medicine,ig,once a day,by mass ratio of eggs to egg shell(cude drug 1∶2.4,salt stir-fried product 1∶1.7,steamed prod-uct 1∶2.1)for consecutive 4 weeks. The urinary volume,body weight,renal index and the serum contents of ADH and ALD were all determined. RESULTS:Compared with blank group,body weight and serum content of ADH and ALD decreased in model group,while renal index and urinary volume increased(P<0.05). After 4 weeks of treatment,compared with model group,body weight and serum content of ADH increased in Ootheca Mantidis groups,while urinary volume and renal index decreased (P<0.05);serum content of ALD increased in treatment groups;there was statistical significance in the serum content of ALD in those groups except Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group and steamed Ootheca Mantidis group (P<0.05);except for ALD,those index were in descending order of steamed Ootheca Mantidis group>Ootheca Mantidis stir-fried with salt group>Ootheca Mantidis group,and steamed Ootheca Mantidis shell group had best exchange. CONCLUSIONS:The an-tidiuretic activity of Ootheca Mantidis has been enhanced after processing. The egg shell of steamed Ootheca Mantidis is main me-dicinal part. To increase the serum content of ADH might be one of the main mechanism of arresting polyuria.

ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP< 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73),Z = -2.447,P< 0.001]. With exacerbation of illness, APACHEⅡ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P< 0.05 orP< 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823,P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHEⅡ score (r = 0.351,P = 0.031), PCT (r = 0.412,P = 0.005), IL-6 (r = 0.535,P = 0.030), IL-1β (r = 0.674,P = 0.030), TNF-α (r = 0.250,P= 0.030), sST2 (r = 0.620,P< 0.001), and length of stay in ICU (r = 0.296,P = 0.013), duration of mechanical ventilation (r = 0.385,P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37,F = 7.798,P< 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283,P> 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.

Chronic hepatitis B infection is a very important health problem in China, which is carrying an enormous economic and social burdens. The major routs of chronic hepatitis B infection in China are mother-infant vertical transmission and early childhood horizontal transmission. After more than 10 years implementation of universal vaccination against hepatitis B in newborns and safety injection in health care settings, the prevalence of HBsAg in general population has decreased from 9.75% to around 7%. In China, patients with hepatitis are cared by either hepatologists or physicians of infectious diseases. The Chinese Society of Hepatology, and Chinese Society of Infectious Diseases jointly issued an evidence-based guideline on the prevention and treatment of chronic hepatitis B in 2005. This guideline concisely describes the virology, epidemiology, natural history and prevention, as well as diagnosis and management of chronic hepatitis B. It also highlights the importance of active viral replication in disease progression in chronic HBV infection and explicitly states the necessity of antiviral therapy in patient care. The cornerstone of anti-hepatitis B therapy is optimal use of interferons or nucleos(t)ide analogs in those patients with active viral replication and elevated serum transaminase levels. Through an independent continue medical educational agency, a panel of selected speakers were trained to give well-formatted talks on the key points of the guideline in over 60 major cities across China. This educational campaign among health care providers has greatly improved the awareness and the stand of care for antiviral therapy.

Objective To explore the effect and safety of the regimen containing Moxifloxacin in intensive phase for pulmonary tuberculosis patients. Methods 88 cases with initial tuberculosis(each group of 44 cases) were studied in comparison in the same period. The treatment group contained isoniazid, rifampicin and moxifloxacin of antituberculosis regime and the control group contained isoniazid,rifampicin and pyrazineamide. Results After 2 months intensive phase anti-tubercular treatment ,the sputum negative conversion rates was 95.0% and control's was 94.4%(P ＞ 0.05); the absorb rate of lesions: the treatment group 77.3 % and the control group 79.5%; the liver damage rate: the treatment group and control group was 68.2% ,34.1% respectively(P ＜ 0.05). Conclusion Anti-tuberculosis intensive phase regimes containing moxifloxacin for tuberculosis treatment was safe and effective in initial treatment of pulmonary tuberculose.

In order to provide some more scientific and practical advice and tactics for acupuncture in prevention of migraine in clinic, a computer-based information search was conducted in MEDLINE database, and the current reports of clinical trials were summarized and a comparison of Western and Chinese research designs was made. The significant role of acupuncture for prevention of migraine has not been applied in wide range in China until the present day. However, it has been paid great attention in Western countries. This situation might be related to the differences of efficacy assessment of acupuncture between China and Western countries; meanwhile, in the past traditional acupuncturists put much stress on the therapeutic approaches for acute attacks of headache but less on prevention. It is necessary for Chinese doctors to learn from research method in the West and emphasize more on acupuncture for preventing migraine and conduct high-level clinical trials as well. The author recommends that Chinese doctors should select acupuncture points mainly according to meridian syndrome differentiation and apply long term intermittent interventions.

The concepts of monomer medicine and the Chinese traditional medicine were introduced in this article. The different effects of a monomer drug between different types of syndromes of traditional Chinese medicine (TCM) were explained based on the author's clinical experience and related literature. The aim, significance and methods about the application of western medical drugs according to the theory of TCM were pointed out. And the feasibility of the application was analyzed.

A major hurdle that humbles the modernization of traditional Chinese herbal medicine (CHM) is the inconsistency of chemical composition, which is inevitable due to the natural origins of CHM. Here I propose a concept of a new category of drugs, named "post-absorption/metabolism multicompound drug (PAMD)" that will meet every standard of modern pharmaceuticals, yet maintain the fundamental principle of traditional Chinese medicine, which is an integrative therapeutic approach through multiple mechanisms by a cocktail of various herbs. The PAMD concept is based on the fact that the most of chemical ingredients in an orally taken CHM remedy may never enter the blood stream owing to the poor gastrointestinal absorption. Only a few original ingredients or, most likely, a few metabolites of those absorbed ingredients are found in the blood or target organs. The compounds after the absorption/metabolic process are the only ones responsible for pharmacological functions of the remedy. Given the limited number of species, those compounds, once isolated and tested for their pharmacological activity, can be formulated with designed ratios to form new drugs that should theoretically possess an equivalent or better therapeutic efficacy than the original CHM remedy. Strategies of developing PAMDs and possible difficulties are also discussed.

Troponin is an important biomarker of acute coronary syndrome.Especially highsensitivity cardiac troponin in recent years played an important role for the early diagnosis and prognosis of myocardial infarction.Recommendations for the use of high-sensitivity cardiac troponin have been issued in some guidelines.But the clinical doctors and laboratory workers still have many problems in practice.Some problems in high-sensitivity cardiac troponin assay and the clinical application were introduced here.Suggestions were also put up from international organizations,including unified high-sensitivity cardiac troponin name,unit,establish healthy population,selection guidelines to identify the 99th percentile value.

Objective To summary Jiangsu Province Hospital of TCM Professor Xia GuiCheng's experience on treatment of infertility by the method of Tonifying the Kidney and Regulating the Period of Menses(TKRPM), meanwhile to observe the clinic curative effect of TKRPM combined with clomiphene for infertility.Methods The patients were randomly recruited into a TCM group and a TCM combined western medicine group by digital randomized methed,30 cases in each group.The TCM treated group was treated by the method of TKRPM, while the other group was treated by TCM combined with clomiphene. Both groups were treated for three months.Syndromes, basal body temperature, results of B ultrasonic, and hormone in serum were observed. Results In TCM treated group , the clinic effective rate was 93.3%, the pregnant ratio was 33.3%, mean-cure-time for pregnant was(8.20±2.35)months; while in TCM combined western medicine group, the clinic effective rate was 100%, the pregnant ratio was 20%, and mean-cure-time for pregnant was (5.17±1.72) months.The clinic effective rates (U=0.358) and the pregnant ratios (x2=1.346) of two groups were not markedly difference (P＞0.05), but the mean-cure-time for pregnant of the two groups was markedly difference(P＜0.05). Conclusion TKRPM combined with induction drugs can cure infertility in a shorter time than using TCM only. Western medicine improves endocrine environment,while traditional Chinese medicine regulates the relationship among kidney, TianGui and the uterus fundamentally. The method will be more acceptable to patients.

Surgical resection offers hilar cholangiocarcinoma patients the only chance for cure and long-term survival.Hepatectomy,extrahepatic bile duct resection,regional lymphadenectomy and hepatojejunostomy are the current treatment of choice for most patients with hilar cholangiocarcinoma.Because of the aggressive nature of hilar cholangiocarcinoma and the absence of effective adjuvant therapy,surgical therapy still remains a challenge to hepatopancreatobiliary surgeons even in the precise surgery era.Controversies exist over preoperative assessment and staging,the use of preoperative biliary drainage,preoperative portal vein embolization,the range of hepatic resection,portal vein resection and construction,hepatic arteriectomy and the range of lymphadenectomy.This article reviews the surgical management of hilar cholangiocarcinoma with a focus on these controversies.