ObjectiveTo investigate the therapeutic effect of Xiaoqinglong decoction for supplementary treatment of patients with ventilator-associated pneumonia (VAP).Methods Thirty-three VAP patients with syndrome of traditional Chinese medicine (TCM) as interior retention of phlegm and exopathic cold admitted to Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine (TCM) from July 2011 to December 2014 were enrolled, and their historical data were retrospectively analyzed. According to the difference in treatment methods, the patients were divided into TCM treatment Xiaoqinglong decoction group (observation group, 18 cases) and general treatment group (control group, 15 cases). The patients in both groups were given conventional western medicine treatment, including anti-infection, phlegm elimination and cough relieve, protection of gastric mucosa and organ function, nutritional support, prevention of bedsore and thrombosis, etc. Additionally, the patients in TCM treatment group were given Xiaoqinglong decoction (drug composition: herba ephedrae 15 g, ramulus cinnamomi 15 g, herba asari 15 g, rhizoma zingiberis 15 g, chinese peony 15 g, rhizoma pinelliae 15 g, fructus schisandrae 15 g, radix glycyrrhizae preparata 10 g) for nasal feeding, once 150 mL, twice a day, once every 7 days. The changes in body temperature were observed before and 3 days and 7 days after treatment, and peripheral blood was collected for determination of white blood cell count (WBC) and C-reactive protein (CRP) level in the two groups. Comprehensive therapeutic effects of the patients in both groups were recorded.Results There were no significant differences in body temperature, WBC and CRP before treatment between the two groups. After treatment, the above parameters in both groups were significantly lower than those before treatment, and they showed a decrease tendency with time prolongation. The decrease in body temperature and WBC in observation group was more obvious than those of control group, and the comparisons showed statistical significant differences on 7 days after treatment [body temperature (℃): 36.5±0.6 vs. 37.0±0.8, WBC (×109/L):6.7±3.0 vs. 8.9±2.5, bothP < 0.05], but there was no significant difference in CRP between the observation group and control group (mg/L: 3 d was 73.7±20.5 vs. 61.5±18.4; 7 d was 27.2±10.5 vs. 23.5±9.1, bothP > 0.05). The total effective rate on the 7th day after treatment in observation group was higher than that of control group [83.3% (15/18) vs. 80.0% (12/15)], but no statistical significant difference was seen (P > 0.05).Conclusions The Xiaoqinglong decoction can reduce the inflammatory reaction of patients with VAP, and improve their symptoms.

Objective: To explore the comprehensive effects of folic acid (FA), riboflavin (RF) and MTHFR C677T polymorphism on genomic stability. Method: Cytokinesis-block micronucleus assay was used to detect the effects of different concentration combination of FA (20 and 200nmol/L, i.e. LF and HF) , RF (1 and 500 nmol/L, i.e. LR and HR) and MTHFR C677T polymorphism on genomic stability of 9 d cultured human lymphocytes. Results: The genetic damage was significantly higher in LFHR group regardless the genotype (P

This article introduces the clinical requests of indigenous diagnostic imaging ultrasound devices in first-time registration application and the clinical trial requests in Technical Review Guidance of Ultrasound Imaging Diagnostic Devices (category III) Registration and puts forward some questions of the guidance's implementation. It is hoped to help concerned people.
China ; Clinical Trials as Topic ; standards ; Device Approval ; legislation & jurisprudence ; standards ; Guidelines as Topic ; Ultrasonography ; instrumentation

FGF21 (fibroblast growth factor 21) is a recently described member of the FGF family. It has been previously demonstrated that FGF21 is a potent regulator of glucose homeostasis. To improve stability of FGF21 for better efficacy, a new form of recombinant FGF21 was generated by fusion of a full length FGF21 gene and the Fc fragment of human IgG4 with flexible linker sequence. To examine the glucose regulation activity of FGF21-L-Fc, 3T3-L1 pre-adipocytes were differentiated into adipocytes, and glucose uptake activity of FGF21-L-Fc was examined by glucose oxidase and peroxidase (GOD-POD) assay. The results showed that in comparison with wild type FGF21, FGF21-L-Fc was more potent in stimulation of glucose uptake by 3T3-L1. In vivo studies on the modified protein demonstrated that FGF-L-Fc had a better efficacy in lowering blood glucose of the STZ-induced diabetic animals and controlled glucose level for a longer time. The results provided a sound basis for further studies.

Objective To investigate the relationship of pathological response of breast cancer after neoadjuvant chemotherapy with the imaging findings in dynamic contrast-enhanced MRI.Methods Forty- five patients with pathologically confirmed breast carcinoma who finished courses of neoadjuvant chemotherapy had breast MRI prior to operation.Dynamic contrast-enhanced MRI scans were performed on a 1.5 T scanner using 3D SPGR sequence before and repeated 6 times after administration of Gd-DTPA. Pathological response was assessed by a pathologist according to Miller & Payne five points classification blinded to breast MRI results.Grade 5 was defined as pCR(pathological complete response).Grade 4 and 5 were defined as major histopathological response(MHR).The type of time signal intensity curve(TIC) (three types),pattern of residual enhancement of each breast cancer were recorded and correlated with pathological findings.Fisher exact test was used for statistical analysis.Results Grade 5 responses were achieved in seven patients;grade 4 in sixteen patients;grade 3 in sixteen patients and grade 1—2 in six patients.70.0%(14/20)of type Ⅰ time signal intensity curve correlated with MHR,while all 6 type Ⅲ curves showed non-MHR response.The type of time signal intensity curve and pathological response grades had statistically significant correlation(P=0.001).18 of the 23 cases with MHR exhibited residual enhancement,while the remaining 5 cases showed no enhancement.Of the 18 MHR cases with residual enhancement,11 showed non-mass-like enhancement and 7 showed mass-like enhancement.The mass(non- mass)morphological pattern in dynamic contrast enhanced-MRI had statistically significant differences in pathological response(P=0.012).Conclusions Pathological response of breast carcinoma after neoadjuvant chemotherapy could be characterized using dynamic contrast-enhanced MRI by identifying patterns of residual contrast enhancement and kinetic curve.Favorable pathological responses correlated with Type Ⅰ TIC,non-enhancement,and non-mass-like residual enhancement.

Objective To explore the effect of warming yang for diuresis method combined with blood purification on the clinical therapeutic effect of patients with acute renocardiac syndrome (ARCS).Methods Sixty ARCS patients admitted to the Department of Intensive Care Unit (ICU) of Affiliated Hospital of Tianjin Institute of Chinese Medicine from May 2013 to October 2016 were enrolled, they were divided into an observation group and a control group by random number table, 30 cases in each group, one case died of multiple organ failure due to aggravation of infection, thus the actual observation number was 29 patients in the control group. The continuous vein-vein hemofiltration (CVVH) was applied in the two groups, 6-13 hours each time, and according to the disease situation, the continuous ultrafiltration time was determined, generally about 3-7 days; the observation group was additionally treated with warming yang for diuresis oral herbal decoction, 1 dose daily, 2 times a day, once 100 mL orally taken. The changes of cardiac and renal function indexes, traditional Chinese medicine (TCM) syndrome score and clinical efficacy were observed before and after treatment in the two groups.Results After treatment, the heart and renal function indexes were significantly improved, serum creatinine (SCr), urea nitrogen (BUN), N-terminal pro-brain nitric peptide (NT-proBNP) were all significantly lower than those before treatment in both groups, glomerular filtration rate (GFR), urine output, left ventricular ejection fraction (LVEF), cardiac output index (CI) were all significantly higher than those before treatment in both group; 7 days after treatment, BUN was significantly lower in observation group than that in control group (mmol/L:10.38±1.02 vs. 13.68±2.67), GFR, urine output, CI were significantly higher in observation group than those in control group [GFR (mL/min): 62.02±4.47 vs. 52.95±1. 92, urine output (mL/24 h): 875.41±44.26 vs. 537.82±79.65, CI (L·min-1·m-2): 3.12±0.51 vs. 3.07±0.17, allP < 0.05]; the effective rate of TCM syndrome score and clinical efficacy were significantly higher in observation group than those in control group [total effective rate of TCM syndrome score: 80.0% (24/30) vs. 55.17% (16/29), total effective rate: 93.33% (28/30) vs. 72.41% (21/29), both P < 0.05].Conclusions The warming yang for diuresis TCM decoction intake combined with CVVH can improve the cardiac and renal functions and clinical symptoms, and increase urine output for patients with ARCS.

The heart and kidney damage is a clinical disease commonly seen, the 2 organs can interact with each other as cause and effect, leading to a series of clinical symptoms which is the cardiorenal syndrome (CRS). In 2008, according to the connection between the heart and kidney, the nephrologists Ronco, etc, completed the definition and classification of CRS, including type Ⅰ and type Ⅲ of CRS being acute cardiorenal syndrome (ACRS). ACRS refers to the fact that when the damage of heart or kidney dysfunction influences each other leading to a clinical syndrome caused by a sharp deterioration of cardiorenal function. At present, no definite diagnostic criteria for ACRS have yet been made. The pathogenesis of ACRS may be related to the renin-angiotensin-aldosterone system (RAAS), nitric oxide-reactive oxygen species (NO-ROS) system, inflammatory reaction, the excessive activation of sympathetic nervous system and so on. Clinically, about 50% of ACRS patients are accompanied by acute decompensated cardiorenal dysfunction or failure, that seriously impact on the patients' clinical prognosis and survival rate, so it is necessary to find an effective therapeutic regimen. At present, the treatments of ACRS have mainly the diuretic, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor inhibitor (ARB), β-receptor blocker, positive inotropic drugs, recombinant human erythropoietin, recombinant human brain natriuretic peptide, continuous blood purification (CBP) etc, and traditional Chinese medicine (TCM) also has a certain effect for improving the clinical symptoms of ACRS patients. Now the pathogenesis, diagnosis, and combined treatment of TCM and western medicine for treatment of ACRS are summarized.

OBJECTIVETo study the biomechanical characteristics of Ni-Ti shape-memory alloy-enclosed interlocking intramedular nail Ni-Ti En for clinical application.

METHODSSix transverse fractures were induced in 6 fresh humeral shafts and fixed with Ni-Ti En, plate, interlocking intramedullary nail, and Ender nail, respectively. The specimens then underwent stress analysis for comparison of the bending strength, twisting force, and flexibility.

RESULTSThe bending strength of Ni-Ti En was not significantly different from that of the plate and better than ender's nail; the twisting force of the interlocking intramedullary nail was comparable with the plate, but better than Ender nail.

CONCLUSIONNi-Ti Enpossess good biomechanical property to meet the demand of osteosynthesis, and its less stress protection, freedom of distant nail locking, flexibility and stable fixation may accelerate fracture healing.

Biomechanical Phenomena ; Bone Nails ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Nickel ; Titanium

BACKGROUNDNominal atrioventricular (AV) interval in dual chamber pacemaker (DDD) is not the best AV delay in the majority of patients with atrioventricular block. To find a simple method for optimizing AV delay adjustment, we assessed surface electrocardiography (ECG) for optimizing AV delay during dual chamber pacing.

METHODSDDD pacemakers were implanted in 46 patients with complete, or almost complete, AV block. Optimal AV delay was achieved by programming an additional delay of 100 ms, to the width of intrinsic P wave or to the interval between pacing spike to the end of P wave on surface ECG. Left ventricular (LV) end diastolic and end systolic volumes, ejection fraction and diastolic parameters were measured by Doppler echocardiography during both nominal and optimal AV delay pacing.

RESULTSCompared to nominal AV delay setting, LV end diastolic volume increased [to (53.2 +/- 11.3) ml from (50.2 +/- 10.2) ml, P < 0.05], end systolic volume decreased [to (26.1 +/- 9.0) ml from (27.9 +/- 8.2) ml, P < 0.05] during adjusted AV delay pacing, resulting in an increase in LV ejection fraction [to (68.2 +/- 5.3)% from (64.5 +/- 4.3)%, P < 0.05]. LV diastolic filling and isovolumic relaxation time were not significantly changed.

CONCLUSIONOptimization of AV delay by surface ECG is a simple method to improve LV systolic function during dual chamber pacing.

Adult ; Aged ; Aged, 80 and over ; Atrioventricular Node ; physiopathology ; Cardiac Pacing, Artificial ; methods ; Electrocardiography ; methods ; Female ; Heart Block ; physiopathology ; therapy ; Humans ; Male ; Middle Aged ; Time Factors

OBJECTIVETo establish corresponding set pair analysis mathematic model using the clinical symptoms of blood-heat type psoriasis vulgaris (BHTPV), thus guiding the clinical accuracy of clinical syndrome typing.

METHODSRecruited were 202 BHTPV with complete data after they were treated by yang subduing blood cooling method. Their clinical symptoms and signs were systematically collected. Using set pair analysis method, the therapeutic results of cured and markedly effective were recruited as the same portion, of effective as the different portion, and of ineffective as the contrary portion. The U value of each syndrome factor was calculated according to the formula. The correlation factor of syndrome typing of BHTPV was screened. The syndrome typing model of BHTPV was established according to the correlation factor.

RESULTSThe main factors of BHTPV included the scale integral > 2.04, the erythema integral > 2.34, age > 50 years old, the area integral > 2.07, dry mouth, slippery pulse, yellowish fur, soggy pulse, dry and hard stool. The secondary factors included less sweat, insomnia, frequent pulse, any infiltration, erythra of any area, red tongue, depression, the disease course ranging 1-360 months, age ranging 16-50 years old, string-tight pulse, thin fur, the area integral ranging 0-2.07, white fur, purplish tongue, the scale integral ranging 0+ -2.04, and feeble pulse. The third factors included the erythema integral ranging 0-2.34 and pale red tongue. The set pair analytical model of BHT-PV was as follows: U = sigma An/N + sigma B(m)i/M + sigma C(p)j/P.

CONCLUSIONSU blood-heat syndrome > or = 0.75 could be judged as blood-heat syndrome. Satisfactory efficacy could be achieved by blood cooling method. For patients with U blood-heat syndrome < 0.75, no satisfactory efficacy could be achieved by blood cooling method alone since they were accompanied with other syndrome types.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Psoriasis ; diagnosis ; Young Adult