Objective To study the pathological changes of acute hemorrhagic necrotizing pancreatitis(AHNP) complicated with acute lung injury(ALI). Method The model of AHNP with ALI was established in rats. The changes of function and structure of pancreas and lung were observed. Results One hour after induction of the model , pancreas showed mild edema and congestion . 12 hours after introduction of the model , the typical pathological changs of AHNP were found . The lung extravascular water volume and levels of PaCO 2 increased significantly, and the PaCO 2 decreased obviously. Morphological examination demonstrated that inflammatory cell , insterstitial edema , intra-alveolar hemorrhage ,desquamate and disintegration occurred in the lungs. Conclusions The pancreatic and pulmonary morphologic changes in this model is similar to the changes in clinical AHNP with ALI , which suggests that the model can be used to study the mechanism of AHNP with ALI and evaluate the effect of drugs for AHNP with ALI.

Objective To explore the relationship between the level of serum Klotho with renal impairment in chronic kidney disease (CKD) patients. Methods 100 patients with CKD 1-5 stages (CKD group) and 30 non-CKD patients (control group) were enrolled. The serum of Klotho was detected by ELISA (enzyme-linked immunosorbent assay ) to investigate the correlation between the level of serum Klotho to progression of CKD. Results The levels of serum Klotho in CKD group 9.81 (7.45,12.2) ng/mL and control group 2.97 (1.75,5.23) ng/mL were significantly different (P < 0.01); The Klotho level declined as renal insufficiency progressed. Pearson correlation analysis showed that serum Klotho in CKD patients was positively correlated with eGFR (estimated glomerular filtration rate), blood calcium and hemoglobin,while was negatively correlated with phosphate, age, logserum creatinine, and logFGF-23. Multiple regression analysis showed age, logScr and logFGF-23 were independent factors for expression of serum Klotho in CKD patients. Conclusion Serum Klotho level in CKD patients decreased with the deterioration in renal function and serum Klotho maybe one of indicators to predict the progression of renal function in CKD patients.

Objective:To explore the influencing factors of neutrophil to lymphocyte ratio (NLR) in patients with chronic heart failure (CHF) and the relationship between NLR and cardiac contractile function.Methods:From September 2016 to May 2018, 135 CHF patients were enrolled in the cardiovascular department of Fenyang hospital, Shanxi Province for prospective research.According to the level of NLR, the patients were divided into three groups: low NLR group (<2.3, 46 cases), middle NLR group (≥2.3~≤4.3, 45 cases), high NLR group (>4.3, 44 cases). The basic clinical data, laboratory examination data and noninvasive cardiac hemodynamic indexes of the three groups were compared.Results:(1) By comparing the data of different NLR groups, we found that there were significant differences in (N-terminal pro-brain natriuretic pepfide, NT-proBNP)( F=4.485, P=0.013), total bilirubin( F=6.085, P=0.003), albumin( F=3.695, P=0.027). (2)NLR was correlated with NT proBNP, total bilirubin, albumin( r=0.267, 0.256, -0.243, P=0.002, 0.003, 0.005, respectively). (3)Multiple linear regression analysis showed that NLR of CHF patients was correlated with left ventricular ejection fraction (LVEF), NT proBNP, total bilirubin and albumin (standard regression coefficients were -0.239, 0.223, 0.247 and -0.213, respectively, P<0.05). (4) Pearson correlation analysis showed that NLR and cardiac output ( r=-0.173, P=0.045), cardiac index ( r=-0.175, P=0.042), LVEF ( r=-0.278, P=0.001), maximum ejection velocity ( r=-0.207, P=0.016), systolic index ( r=-0.214, P=0.013), hearther index(HI) ( r=-0.179, P=0.038), cardiac work (CW) ( r=-0.235, P=0.006), cardiac workindex (CWI)=( r=-0.244, P=0.004) were negatively correlated. Conclusion:NT-proBNP, total bilirubin, albumin and LVEF are the factors that affect the NLR of patients with CHF.NLR has a certain value in the evaluation of CHF, therapeutic effect and prognosis prediction.

Objective:To investigate the current situation of cytomegalovirus (CMV) infection in infants in Lishui, and summarize the related factors of CMV infection, evaluate its influence on the growth and development of infants, and provide evidence for the prevention and control of CMV infection.Methods:In this study, 2 254 cases of infants admitted in pediatric ward in Lishui Maternal and Child Health Hospital, Qingtian County People′s Hospital, Suichang County People′s Hospital, Qingyuan County People′s Hospital from January 1, 2015 to December 31, 2017 with integral clinical data were selected. All the babies were followed up from the time when they were born to 1 year old. The serum CMV antibody and the urine CMV-DNA were screened, the general situation and clinical features of CMV infection were summarized, and the relevant factors of infants CMV infection were analyzed and screened by the single factor and multiple factors analysis. They were followed up to 1 year old to clarify the influence of CMV infection on the growth and development of infants.Results:From 2015 to 2017, the total positive infection rate of CMV-IgM in infants under 1 year old in Lishui was 10.43%(235/2 254), and CMV-IgM positive infection decreased year by year. The positive rate of CMV-IgG did not change significantly with time. The positive rate of CMV-IgM was the highest at 1—3 months, and up to 15.29% (61/399). The positive rate of CMV-IgM decreased with the age of the babies. The positive rate of CMV-IgG increased with the age of the babies. The positive rate of CMV-IgM in infants showed no significant difference in gender ( P>0.05). The positive rate of CMV-IgM was higher in men than that in women [65.43% (810/1 238) vs. 55.51% (564/1 016)], and there was significant difference ( P<0.05). The gestational age of the infected group was lower than that of the non-infected group [(37.41 ± 1.63) weeks vs. (38.97 ± 0.97) weeks], and the breast-feeding rate of the infected group was higher than that of the non-infected group [57.87%(136/235) vs. 40.00%(40/100)], and there were significant differences ( P<0.05). Thrombocytopenia, the increase of transaminase, necrotizing enterocolitis of newborn, and hepatosplenomegaly of infected group is higher that of the non-infected group [18.72%(44/235) vs. 1.00% (1/100), 29.36% (69/235) vs. 13.00% (13/100), 26.81% (63/235) vs. 10.00% (10/100), 9.79% (23/235) vs. 0], and there were significant differences ( P<0.05). Gestational age and breast-feeding were possible risk factors for CMV infection in infants under 1 year old ( P<0.05). There was no significant difference in height, weight, head circumference and intelligence score between the infected group and the non-infected group at the age of 1 year ( P>0.05). The total abnormal rate of hearing development and the abnormal detection rate of B-ultrasound in the infected group were higher than those in the non-infected group [13.62%(64/470) vs. 1.00%(2/200), 6.38%(15/235) vs. 0], and there were significant differences ( P<0.05). Conclusions:The CMV active infection rate of infants under 1 year old in Lishui is relatively high and decreases year by year. It decreases with the prolongation of birth time, and there is no gender difference. Gestational age and breast-feeding are the risk factors for active CMV infection in infants. CMV infection affects the hearing development and the brain development of infants under 1 year old, which is the main cause of hepatitis. It is necessary to pay attention to the prevention of CMV infection, strengthen maternal perinatal health care, and strengthen the screening of CMV infection in high-risk groups.

This paper summarized Professor ZHANG Junping's clinical experience in treating coronary heart disease （CHD） combined with hypothyroidism. It is believed that yang deficiency was the root cause of CHD complicated with hypothyroidism， and also the key pathogenesis throughout its development. Accordingly， combined with the different focuses on the lesions in the blood， pulse， heart and spirit， Professor ZHANG took warming yang as the basic rule and summarized the four methods of warming yang for syndrome differentiation and treatment. When spleen-kidney yang deficiency， disturbance of qi transformation， dysfunction of blood transportation as the pathological basis of CHD combined with hypothyroidism， the self-prescribed Butian Formula （补天方） could be used for warming yang and benefiting the kidney， thereby regulating Qi and blood； when the cold and dampness blocked the blood vessels， and turbidity-toxin generated gradually， resulting in heart vessel obstruction， the self-prescribed Huazhuo Changmai Decoction （化浊畅脉汤） could be used to warm yang and dissolve the turbidity so that to unblock the heart vessels； when the structure and function of the heart fail， edema due to yang deficiency with pericardial fluid retention， the self-prescribed Yuxin Baomai Formula （育心保脉方） could be used to warm yang and excret water， and protect the heart； when yang deficiency led to emotional and mental stagnation， and the heart impairment aggravated emotional and mental disorders， which resulted in emotional and mental abnormalities， the self-prescribed Jieyu Anshen Decoction （解郁安神汤） could be used to relieve emotional and mental stagnation， and calm mind.

With the increasing incidence of diabetes mellitus in recent years， cardiomyopathy caused by diabetes mellitus has aroused wide concern and this disease is characterized by high insidiousness and high mortality. The early pathological changes of diabetic cardiomyopathy （DCM） are mitochondrial structural disorders and loss of myocardial metabolic flexibility. The turbulence of mitochondrial quality control （MQC） is a key mechanism leading to the accumulation of damaged mitochondria and loss of myocardial metabolic flexibility， which， together with elevated levels of oxidative stress and inflammation， trigger changes in myocardial structure and function. Qi deficiency and stagnation is caused by the loss of healthy Qi， and the dysfunction of Qi transformation results in the accumulation of pathogenic Qi， which further triggers injuries. According to the theory of traditional Chinese medicine （TCM）， DCM is rooted in Qi deficiency of the heart， spleen， and kidney. The dysfunction of Qi transformation leads to the generation and lingering of turbidity， stasis， and toxin in the nutrient-blood and vessels， ultimately damaging the heart. Therefore， Qi deficiency and stagnation is the basic pathologic mechanism of DCM. Mitochondria， similar to Qi in substance and function， are one of the microscopic manifestations of Qi. The role of MQC is consistent with the defense function of Qi. In the case of MQC turbulence， mitochondrial structure and function are impaired. As a result， Qi deficiency gradually emerges and triggers pathological changes， which make it difficult to remove the stagnant pathogenic factor and aggravates the MQC turbulence. Ultimately， DCM occurs. Targeting MQC to treat DCM has become the focus of current research， and TCM has the advantages of acting on multiple targets and pathways. According to the pathogenesis of Qi deficiency and stagnation in DCM and the modern medical understanding of MQC， the treatment should follow the principles of invigorating healthy Qi， tonifying deficiency， and regulating Qi movement. This paper aims to provide ideas for formulating prescriptions and clinical references for the TCM treatment of DCM by targeting MQC.

Guided by the concept of "blood-pulse-heart-spirit"， it is believed that stable angina combined with insomnia is caused by disturbance of blood vessels， which leads to loss of nourishment for the heart body and heart spirit， so the core treatment principle is to regulate the blood vessels and calm the mind. At the beginning of the disease， it shows as the liver fails to govern the free flow of qi， and disorders qi and blood； during the progress of the disease， it shows as spleen deficiency and phlegm stagnation， phlegm and blood stasis obstructing the vessels； the central mechanism of the disease shows as disturbance of blood vessels and insufficient heart yin. For the pattern of liver depression and blood stasis， pattern of phlegm and blood stasis blocking the vessels， and pattern of heart yin deficiency， it is recommended to treat by Wuzang Shenning Formula （五脏神宁方） to dredge the liver and regulate the vessels， Banxia Houpo Decoction （半夏厚朴汤） plus Gualou Xiebai Banxia Decoction （瓜蒌薤白半夏汤） to dissolve phlegm and regulate the vessels， and Yunpi Tiaoxin Decoction （运脾调心汤） to nourish the yin and regulate the vessels. Throughout the treatment， pattern differentiation and treatment is accompanied by the method of calming the mind with heavy sedatives and nourishing the blood to calm the mind， so as to achieve the purpose of regulating mind and heart together and treating the body and spirit at the same time.

ObjectiveTo observe the clinical efficacy of the Modified Tongmai Anshen Formula （通脉安神方加减， MTAF） in the treatment of stable angina pectoris （SAP） with sleep disorders. MethodsA total of 148 patients suffering from SAP with sleep disorder were included and randomly divided into control group and treatment group， with 74 patients in each group. The control group received conventional western medicine， and the treatment group additionally received MTAF （1 dose per day）， both for 4 weeks. The changes in angina pectoris symptoms， traditional Chinese medicine （TCM） syndromes， sleep quality， quality of life， serological indicators including serum intercellular adhesion molecule-1 （ICAM-1） and vascular cell adhesion molecule-1 （VCAM-1）， brain-derived nerve growth factor （BDNF） and tyrosine kinase receptor B （TrkB） were compared between groups before and after treatment， and the safety was evaluated. ResultsIn the treatment group and the control group， the total effective rates of TCM syndromes（82.43% vs 52.70%）， angina pectoris （79.73% vs 64.86%） and sleep （89.19% vs 68.92%） showing significant difference （P＜0.001）. After treatment， the total TCM syndrome score， primary symptom score， secondary symptom score， and secondary symptoms sleeplessness， restlessness， tiredness and fatigue individual score， angina pectoris score， PSQI total score and each item score were all significantly reduced in both groups， while the SF-36 single item score significantly increased （P＜0.05）. The total TCM syndromes and primary symptom scores， secon-dary symptoms sleeplessness， restlessness， tiredness and fatigue individual score， angina pectoris score， time to fall asleep， sleep quality， hypnotic medication， sleep disturbance， daytime dysfunction score and PSQI total score were significantly lower in the treatment group than those in the control group after treatment （P＜0.05）， while the somatic pain， general health status， social functioning， emotional functioning， mental health， and health change were significantly higher in the treatment group （P＜0.05）. After treatment， ICAM-1 and VCAM-1 level significantly decreased （P＜0.05）， and BDNF and TrkB levels increased （P＜0.05） in the treatment group， while BDNF level significantly decreased in the control group （P＜0.05）. The TrkB level was significantly higher in the treatment group compared to the control group after treatment （P＜0.05）. A total of four adverse events occurred during the treatment， none of which were considered to be related to this study. ConclusionMTAF can significantly improve angina pectoris symptoms， TCM syndromes， sleep quality and quality of life in patients suffering from SAP with sleep disorders， the mechanism of which may be related to the protection of vascular endothelial function and central neurons.