The author analyzed the main issues in current clinical study of integrative medicine in treatment of renal diseases, and proposed the target-oriented strategy for clinical study of different renal diseases, emphasizing the importance of method improvement for academic innovation.

Objective To summarize our experience in the management of stones impacted at cystic duct during laparoscopic cholecystectomy(LC). Methods There were 58 patients with stones impacted at cystic duct during LC from July 1997 to June 2001.Cystic duct was incised to remove stones first,then intraoperative cholangiography was performed.If stones were found in common bile duct,they would be taken out by intraoperative endoscopic sphincterotomy or open operation. Results All the impacted stones in 58 patients were removed successfully.51 coses underwent LC.Intraoperative cholangiography showed there were common bile duct stones in 7 cases.For these 7 coses,5 cases were treated by LC combined with intraoperative endoscopic sphincterotomy and other 2 cases were converted into open operation.No Severe complication occurred. Conclusions Nearly all cases with stones impacted at cystic duct can receive LC by removing impacted stones through incising the cystic duct and intraoperative cholangiography.If there are any stones in common bile duct,they can be removed by endoscopic sphincterotomy.

Objective]To study the discipline of Guizhi Tang in clinical application, understand further indication of Guizhi Tang to improve clinical efficacy. [Method]After consulting medical cases about Guizhi Tang that are from different medical practitioners, analysis on the discipline of Guizhi Tang in clinical application with the help of six meridian syndrome differentiation, zang-fu differentiation and drug efficacy of Guizhi Tang. [Result]Guizhi Tang can be used to cure urticaria, coronary heart disease, nape carbuncle, high fever, half sweating and diarrhea. The cases of urticaria, diarrhea and nape carbuncle all contain symptoms of tai yang disease.The case of high fever is due to discord of ying-wei. The case of half sweating is due to discord of yin-yang. The case of coronary heart disease reflects Guizhi Tang can regulate spleen-stomach. [Conclusion] The medical cases about Guizhi Tang involve the departments of internal medicine, surgery, gynaecology and pediatrics,such as urticaria, coronary heart disease and so on. Using Guizhi Tang should get help from six meridian syndrome differentiation or zang-fu differentiation. When using six meridian syndrome differentiation, doctors should pay attention to difference of tai yang disease and other five meridian diseases. When using zang-fu differentiation, doctors should attach importance to the feature of Guizhi Tang that involves regulating yin-yang, spleen-stomach and ying-wei.

Objective To observe the effect and adverse reaction of fentanyl ransdermal system on the cancer pain resulted from lung cancer metastasizing to bone.Methods Thirty -two patients with moderate to severe cancer pain of bone metastasis from lung cancer were treated with fentanyl transdermal system.Analgesic effect was observed.The quality of life and adverse reactions were evaluated.Results The PI evaluation were (7.62 ± 1.35)and (1.93 ±2.41)before /after treated with fentanyl ransdermal system.The differences of bone pain between before and after treated were significant(t =3.983,P <0.01).Among the thirty -two patients with moderate to severe cancer pain used by fentanyl transdermal system,complete relief was in 12 cases(37.5%),apparent relief was in 11 cases(34.3%),moderate relief was in 7 cases(21.8%),mild relief was in 2 cases(6.3%),the total relief rate was 93.7%.The adverse reactions included hypersomnia were in 13 cases,dizziness in 11 cases,nausea and vomiting in 6 cases,constipation in 5 cases,pruritus and erythra in 4 cases,dysuria in 2 cases.All above adverse reactions dis-appeared after stopping fentanyl ransdermal system and /or undergoing symptomatic treatment.Conclusion Fentanyl transdermal system is easy to use,the effect is significant,there is few adverse reactions,which can significantly improve quality of life of cancer patients.

Objective To investigate the effect of continuous renal replacement therapy (CRRT) combined with Rhubarb at early stage on inflammatory cytokine in the treatment of severe acute pancreatitis.Methods Fifty two patients with SAP were randomly divided into three groups,the conventional treatment group,the CRRT group,and the combined group.CRRT was inplemented in 48 h after the diagnosis of SAP.APACHE-Ⅱ score,mortality were compared before and after treatment.Double sandwich ELISA method was used to detect the levels of interleukin 22 (IL 22),IL-18 and tumor necrosis factor α(TNF-α).Results The clinical effect in combined group was better than other groups,and the mortality was lower than other groups,but the difference was not statisticaly different(P＞0.05).The levels of IL-22,TNF-α and IL-18 were not significantly different among three groups before treatment (P＞0.05).After treatment,the inflammatory factors decreased in all groups.The levels of IL-18,TNF-and IL-22 in CRRT group and combined group were significantly lower than those in control group (P＜0.05),and the combined group decresed most abviously(P＜0.05).There was no significant difference in APACHE Ⅱ score among the three groups before treatment (P＞0.05),while the APACHE-Ⅱ scores were significantly decreased after treatment,the difference was statistically significant (P＜0.05).After treatment,the APACHE-Ⅱ score of the combined group were significantly lower than the other two groups(P＜0.05).Conclusion The therapy of CRRT combined with Rhubarb at early period in SAP patients can better clean up inflammatory cytokines of IL-22,TNF-,IL-18,so that patients with SAP can get more clinical benefits.

Objective To investigate the role of tracheotomy in children with severe hand foot and mouth disease.Methods Eight children with severe hand foot and mouth disease collected from July 2009 to August 2011 in PICU were retrospectively reviewed.Clinical manifestation and laboratory data were analyzed and followed up.Results Eight patients were enterovirus 71 (EV71) positive.Hormones,intravenous immune globulin,mechanical ventilation and vasodilators had been administered in patients with cardiopulmonary failure.They had severe neurologic sequelae,requiring prolonged intubation.MRI imaging of 7 cases showed abnormal brainstem,pons and medulla oblongata,1 case showed swelling of brain tissue.A total of 8 patients underwent a tracheotomy in mean (25.63 ± 8.86) d.The older was 22 months,the younger was 8 months and the mean age was (13.13 ±4.22) months.Four cases died,the other survived.Two cases were successfully decannulation,the other two were still in the tracheotomy.Conclusion Tracheostomy play an active role in reducing airway resistance,clearing airway secretions,providing the opportunity for subsequent rehabilitation.Eight patients were followed up for three years,neurological sequelae could not be restored.Four cases repeatedly suffer from pneumonia,atelectasis,leading to a serious decline in quality of life.

Tick-borne encephalitis ( TBE) is a well-known central nervous system ( CNS) infection in children. The disease in children is generally milder,although severe illness may occur and even lead to perma-nent impairment of the quality of life due to neuropsychological sequelae. We review the epidemiological and clinical characteristics of tick-borne encephalitis,and summarise biological and virological aspects that are impor-tant for understanding the life-cycle and transmission of the virus. Tick-borne encephalitis virus is a flavivirus that is transmitted by ixodes persulcatus. Tick-borne encephalitis causes acute meningoencephalitis. The serologi-cal diagnosis is usually straightforward. No specific treatment for the disease exists,and immunisation is the main preventive measure.

Objective To investigate the effects of combination of aniso-dosage of Astragalus and Arctium on the glycolipin metabolism and renal lesion in diabetic rats.Method Streptozotocin (STZ)-induced diabetic rats were established as experimental model.The diabetic rats were randomized into model group and mixture-treated group.Astragalus and Arctium were divided into three dosages (low,moderate,high) respectively and combined according to orthogonal experimental design and were administrated to the mixture-treated group.At the 4th and 8th week,parameters of blood,urine and renal tissue were examined.The blood sugar,cholesterol,triglycerol,HbA1c were detected by analysis meter of biochemistry,urine microalbumin by radioimmunoassay (RIA) and 24 h urine protein by colorimetry.The HE and PAS staining were used to observe the change of glomerular ECM.Results At the 4th weekend,the combination of Arctium high-dosage had better effects on decreasing blood sugar and cholesterol.While at the 8th weekend,the effects of mixture were gradually augment with the Astragalus dosage increasing on decreasing triglycerol,24 h urine protein and ECM.Conclusion The compatibility of aniso-dosage of Astragalus and Arctium could rectify the metabolic disturbance of glycometabolism and lipid metabolism,and lessen the renal lesions.The compatibility had different effects on various experiment phases.

AIM: To investigate the influence of Fructus Arctii and its extracts to the renal pathological changes of diabetic rat and its protective mechansim METHODS: The rat model induced by 55mg/kg STZ once intraperitoneally was adoped as the diabetic nephropathy of early stage, the extract and the powder of Fructus Arctii were given to the diabetic rat for six weeks. We observed the changes of general condition, and examined the expressions of TGF-? 1 (transforming growth factor-? 1) mRNA and MCP-1mRNA (monocyte chemoattractant protein-1) by reverse transcription-polymerase chain reaction (RT-PCR). CONCLUSION: The ethanol extract of Fructus Arctii relieved renal pathological changes of diabetic rat. The mechanism perhaps was related to the reduction in the expression of MCP-1mRNA and TGF-? 1mRNA in kidney; The study proved that the ethanol extract of Fructus Arctii was more effective than its water extract and coarse powder.