Objective To explore an optimal scheme for diagnosis and treatment of patients with acute viral myocarditis (AVM) with an experience prescription of professor Zhang Zengying, Junkang oral liquid.Methods A prospective study was conducted. Sixty patients with AVM admitted into the Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine (TCM) from March 2012 to January 2014 were randomly divided into two groups: a control group and a treatment group (each, 30 cases). The patients in control group were treated with routine western medicine, including antiviral drugs, polarized solution, adenosine disodiu, and oxygen inhalation; while in treatment group, besides the comprehensive treatment in the control group, the patients were given Junkang oral liquid (main ingredients: Codonopsis pilosula, Salvia miltiorrhiza, Polygonatum odoratum, Notopterygii, Paris polyphylla Smith var. chinensis Hera, Forsythia suspensa, rhizome Ligustici Chunxiong, Hedyotis diffusa, Ophiopogonis tuber), 10 mL each time, three times a day; the treatment was consecutively applied for 3 months in both groups, 15 days constituting one therapeutic course. The changes of cardiac function [heart ejection fraction (EF), stroke volume (SV)] and myocardial enzyme [creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB), aspartate aminotransferase (AST), lactate dehydrogenase (LDH)], and the TCM syndrome integral score, symptoms and signs such as fever with chills, palpitation or severe palpitation, oppressed feeling in chest, deficiency of qi and disinclination to talk, dizziness, weakness and shortness of breath, spontaneous sweating, night sweating, body limb aches, premature beat shown on electrocardiogram (ECG) and curative effect were observed before and after treatment in the two groups.Results Compared with those before treatment, in the two groups after treatment, the EF and SV were significantly elevated, while the CK, CK-MB, AST, LDH, TCM syndrome integral score were obviously decreased, the degree of improvement in the treatment group being more prominent [EF: 0.601±0.088 vs. 0.538±0.084, SV (mL): 67.02±6.78 vs. 61.03±5.88, CK (U/L): 76.25±28.41 vs. 92.54±31.68, CK-MB (U/L): 18.34±8.94 vs. 22.45±9.70, AST (U/L): 31.29±14.28 vs.33.45±11.21, LDH (μmol·s-1·L-1): 2.28±0.51 vs. 2.34±0.68, TCM syndrome integral score: 12.34±1.24 vs. 18.36±1.98, allP < 0.05]; the degrees of improvement in symptoms and signs such as palpitation or severe palpitation, oppressed feeling in chest, shortness of breath, exhaustion, etc and the total effective rate of premature beat in treatment group were significantly higher than those in the control group [palpitations or severe palpitation: 92.59% (25/27) vs. 75.87% (22/29), oppressed feeling in chest: 92.00% (23/25) vs. 76.92% (20/26), shortness of breath exhaustion: 90.00% (18/20) vs. 76.19% (16/21), premature beat: 88.24% (15/17) vs. 75.00% (12/16), allP < 0.05], and the comparisons of total effective rates between the two groups including fever with chills [100.00% (15/15) vs. 93.75% (15/16)], deficiency of qi and disinclination to talk [88.00% (22/25) vs. 83.33% (15/18)], dizziness [87.50% (7/8) vs. 80.00% (8/10)], spontaneous sweating or night sweating [86.67% (13/15) vs. 80.00% (12/15)] and body limb ache [91.67% (11/12) vs. 84.62% (11/13)] showed no statistical significant differences (allP > 0.05).Conclusion Junkang oral liquid can significantly improve the clinical symptoms in patients with AVM, reverse its acute course and control arrhythmia, showing the advantage in diagnosis and treatment with combination of traditional Chinese and western medicine.

Objective To compare the efficacy of valsartan,benazepril and felodipine on reversal of left ventricular hypertrophy(LVH)in patients with hypertension and the relevant "aldosterone escape phenomena".Methods One hundred eleven patients with hypertension-related LVH were randomly to receive valsartan(80-160 mg/d,n=36),benazepril(10-20 mg/d,n=39)and felodipine(5 mg/d,n=36).Plasma angiotensin Ⅱ(Ang Ⅱ)and aldosterone(Ald)were determined before and 10-14 weeks 20-26 weeks after treatment.Echocardiographic examinations and blood routine,urine routine,blood glucose,blood lipid,liver function and renal function were conducted in all subjects before and after treatment.Results Blood pressure was significantly decreased in all three groups(P0.05).Valsartan increased plasma Ang Ⅱ at 10-14 weeks and furthermore at 20-26 weeks;benazepril decreased plasma Ang Ⅱ initiatively with trend of rebound at 20-26 weeks;however,plasma Ang Ⅱ was kept constantly in felodipine group.Valsartan decreased Ald and sustained during the all treatment period.On contrary,benazepril initiatively decreased Ald which was rebound to baseline level at 20-26 weeks.No change in Ald by felodipine was found during the treatment.After treatment plasma Ald level was significantly related to the reduction of LVH in both valsartan and benazepril groups.36% patients in benazepril group was found to have "aldosterone escape".Conclusion The antihypertensive effect was similar between valsartan,benazepril and felodipine.Although three medications all reversed LVH,but valsartan,benazepril was more effective than felodipine.There was no evidence of aldosterone escape in the long-term treatment with valsartan.Valsartan might have more advantages in reversal of LVH than benazepril.Felodipine had no effect on the plasma level of aldosterone.

Objective To investigate effects of angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism on endothelial function in elderly patients with essential hypertension. Methods Seventy-three elderly patients with uncomplicated essential hypertension and 55 normal elderly people as control were recruited into the study. Their humeral arterial endothelial vasodilatation function was studied with high-resolution ultrasonography and ACE I/D genotypes were determined by polymerase chain reaction (PCR) technique. Results Endothelium-dependent vasodilatation function of the three-genotype subgroups of the elderly patients with essential hypertension was significantly lower than that in the controls with the same genotypes (5.5±1.9 vs 11.9±1.3 in Ⅱ genotypa, 4.7±2.0 vs 10.9±1.6 in ID genotype and 2.9±1.9 vs 9.4±2.6 in DD genotype, with all P<0.01 ). In both groups of hypertensives and normotensives, humeral arterial endothelium-dependent vasedilatation function was significantly lower in those with DD genotype than that in those with Ⅱ genotype (2.9±1.9 vs 5.5±1.9 in hypertensive group and 9.4±2.6 vs 11.9±1.3 in control group, both P<0.05 ). Multivariate linear regression analysis showed that endothelium-dependent vasodilatation function in hypertensive elderly people correlated in linearity with their ACE genotype (P<0.01 ). Conclusions ACE gene I/D polymorphism is associated with abnormal humeral arterial endothelium-dependent vasodilatation function of humeral artery in patients with essential hypertension.

This article summarized the clinical experience of Professor WANG Meng-yong in treating chronic renal failure. The disease is mainly due to deficiency of lung, spleen, and kidney, and the Sanjiao dysfunction and water metabolism disorder of distribution, especially the spleen and kidney deficiency. Reinforcing pleen and kidney should be the basis in clinical syndromes; the superficial symptoms and root causes should be differentiated; the superficial symptoms should be treated if the patients have acute diseases; the root causes should be considered if the patients have chronic diseases; at the same time, the methods of tonifying qi and nourishing yin, protecting stomach qi, dredging intestines and descending turbid substance, invigorating the circulation of blood, and using diuretic of hydragogue to alleviate water retention should be applied, which can significantly improve symptoms of patients with chronic renal failure, delay the disease evolution process, and greatly improve life quality of patients.

To summarize the clinical experience of Professor WANG Meng-yong in the treatment of uric acid nephropathy. Professor WANG believes that the disease is mainly caused by spleen and kidney deficiency, disorder of function of Sanjiao, and pathological products, such as phlegm dampness and blood stasis and other metabolic disorders. Therefore, the treatment should distinguish symptoms and essence. Starting from pathogenesis and pathological features of spleen and kidney deficiency and phlegm dampness and blood stasis, the treatment should flexibly apply the methods of nourishing spleen and kidney, reducing phlegm and dispelling humidity, and activating blood and using diuretic of hydragogue to alleviate water retention, which can greatly reduce side effects caused by the long-term use of Western medicine and the onset of gout, and then to help disease recovery.

To summarize the clinical experience of the diagnosis and treatment of Hashimoto's thyroiditis based on the theory of "loss of nourishment in bright essence". It is believed that damages of the seven emotions and loss of nourishment in bright essence are the root cause of Hashimoto's thyroiditis， so the overall therapeutic principle was proposed as fortifying brain and tranquillizing mind. For patients with Hashimoto's thyroiditis combined with hypothyroidism， the self-prescribed Jiaan Mixture Formula （甲安合剂） with modification is used to fortify brain and tranquillize mind， emolliate the liver and nourish the kidneys； for patients with Hashimoto's thyroiditis combined with hyperthyroidism， the self-prescribed Xinnao Kang Formula （心脑康） with modification is used to fortify brain and tranquillize mind， boost qi， invigorate blood， and unblock the collaterals； and for patients with Hashimoto's thyroiditis combined with nodularity， the self-prescribed Xiaopi Shu Formula （消癖舒） with modification is used to boost qi and nourish yin， and invigorate blood and dissipate masses.

OBJECTIVETo assess the relationship between myocardial regional perfusion using second harmonic myocardial contrast echocardiography (MCE) by venous injection of Levovist and coronary artery stenosis detected by coronary angiography to determine whe ther MCE can be used to detect coronary artery disease (CAD) and its sensitivity and specificity for detecting CAD.

METHODSThirty-six patients who underwent coronary artery angiography and MCE formed the study groups. Ten myocardial segments (5 each in the apical two- and four-chamber views) from the images were scored for detecting myocardial perfusion as follows: 1, normal perfusion; 2, decreased perfusion; and 3, perfusion defect. The arteries were classified as normal or diseased. The diseased arteries were classified into three groups according to the perfusion scores.

RESULTSThere were significant differences in coronary diameter stenosis among the different perfusion score groups (P < 0.001). There were 10 total occluded arteries, and the myocardial perfusion scores were different because of different collateral circulation. In the normal perfusion group (Group A), the coronary diameter stenosis was 65% +/- 12%, and the myocardial perfusion score index was 1 +/- 0.00. In the decreased perfusion group (Group B), the average coronary diameter stenosis was 82% +/- 8%, and the myocardial perfusion score was 1.93 +/- 0.16. The diameter stenosis was less than 85% in 63% of the coronary arteries (including diameter stenosis < or = 75% in 12% of the vessels). The diameter stenosis was 85%-90% in 22% of the coronary arteries and > 90% in 15% of the arteries. In the perfusion defect group (Group C), the average diameter stenosis was 90% +/- 6%, and the myocardial perfusion score index was 2.89 +/- 0.24. The diameter stenosis was > or = 85% in 94% of the coronary arteries, and the diameter stenosis was < 85% and > 75% only in 6% of the coronary arteries. The overall sensitivity and specificity of MCE in identifying angiographic coronary diameter stenosis was 67% and 100%, respectively. The false negative rate was 32.6% for the 108 coronary arteries. Further subdivided analysis showed the sensitivities in Groups A, B and C were 0, 100%, and 100%, respectively. The sensitivity increased with increased lumen diameter stenosis of coronary arteries.

CONCLUSIONSThere is a close relationship between coronary artery stenosis and MCE perfusion scores. MCE with venous injection of new generation contrast can define the presence of CAD and lesion graded classifications. Some disagreements between perfusion score and coronary diameter of stenosis may indicate other factors such as different collateral circulation, which should be further investigated. As artery stenosis increases, the sensitivity of MCE is increased.

Adult ; Aged ; Coronary Circulation ; Coronary Disease ; diagnostic imaging ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity

Humans ; Severe Acute Respiratory Syndrome ; diagnosis ; therapy