OBJECTIVETo explore the effects and mechanism of acupuncture at Zusanli (ST 36) combined with oral administration of Gexia Zhuyu decoction on damp-heat ulcerative colitis at active phase.

METHODSOne hundred and twenty cases of damp-heat ulcerative colitis at active phase, by using random draw method, were divided into an observation group and a control group, 60 cases in each one. Patients in the control group were treated with basic treatment combined with oral administration of Gexia Zhuyu decoction. Based on this, patients in the observation group were additionally treated with acupuncture at Zusanli (ST 36). The treatment was given both for 14 days. The efficacy, each symptom score, serum interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were observed.

RESULTS(1) After treatment, the total effective rate was 98.3% (59/60) in the observation group, which was significantly higher than 86.7% (52/60) in the control group (P<0.05). ( The improvement rates of ulceration, edema, erosion and polyp in the observation group were obviously higher than those in the control group (all P<0.05). (3) After treatment, the symptom scores of diarrhea, bloody purulent stool, abdominal pain, tenesmus as well as inflammatory factors of IL-1beta, IL-6 and TNF-alpha were all improved compared with those before treatment in the two groups (all P<0.05); the differences between the observation, group and control group were statistically significant (all P<0.05). (4) During the 3-month follow up visit, the recurrence rate was 1.7% (1/59) in the observation group, which was significantly lower than 11.5% (6/52) in the control group (P<0.05).

CONCLUSIONThe Gexia Zhuyu decoction combined with acupuncture at Zusanli (ST 36) could effectively improve efficacy, reduce recurrence rate, relieve clinical symptoms and prompt recovery of mucous membrane in patients with damp-heat ulcerative colitis at active phase, which is related with reducing the expression of inflammation.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Colitis, Ulcerative ; drug therapy ; genetics ; immunology ; therapy ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Interleukin-1beta ; genetics ; immunology ; Interleukin-6 ; genetics ; immunology ; Male ; Middle Aged ; Tumor Necrosis Factor-alpha ; genetics ; immunology ; Young Adult

Objective To investigate the expression of Foxp3+ Treg in liver cancer patients receiving liver transplant after immunosuppressive protocols FK506 or Rapamycin and evaluate the rejection prevention.Methods Liver transplant patients were randomly divided into FK506 group (10 cases),and Rapamycin group (10 cases).Real time quantitatve PCR was used to examine Foxp3 mRNA expression of patients' PBMC starting the 2nd month for consecutively 10 months.Foxp3 mRNA and incidences of acute rejection were compared between the two groups.Results Foxp3 mRNA expression was significantly lower in the FK506 group (0.1032 ±0.0943) as compared to that in the Rapamycin group (1.2136 ±0.6738)(t =5.1610,P ＜ 0.01) ;The incidences of acute rejection was significantly lower in the Rapamycin group as compared to that in the FK506 group after operation in the same period (x2 =2.2222,P ＜ 0.05).Conclusions FK506 may suppress the induction of immune tolerance after liver transplantation,while Rapamycin may play an important role in inducing and maintaining graft immune tolerance.Rapamycin is better than FK506 in preventing rejection reaction in liver cancer patients receiving liver transplant.

The present study was to estimate pharmacokinetic parameters of metformin hydrochloride in 20 Chinese healthy volunteers with a limited sampling strategy (LSS), which will provide scientific data for bioequivalence and clinical application. A single dose of metformin was administrated to 20 healthy volunteers. The concentration of metformin in whole blood was determined by validated high performance liquid chromatography (HPLC) method. Multi-linear regression analysis was performed to establish a model to estimate AUC(0-24 h) and Cmax of metformin by LSS method. The LSS models were validated by the Jackknife method. The result indicated: the linearity relationship between AUC(0-24 h) or Cmax and single concentration point was poor. Several models for metformin AUC(0-24 h) or Cmax, estimation were better (r2 > 0.9, P < 0.05). Validation tests indicated that most informative sampling points (C2, C6 for AUC(0-24 h), C1.5, C2 for Cmax) provided accurate estimations of these parameters. So, a multi-linear regression model for estimation pharmacokinetic parameters of metformin by using LSS method is feasible.

Objective To assess the safety and efficacy of adopting different vascular access during autologous peripheral blood stem cells collection.Methods 87 patients received autologous peripheral blood stem cells collection were divided into two groups:One was peripheral vein harvesting group (43 cases),which used the 16G disposable fistula needle for autolo-gous peripheral blood stem cell collection and the other central venous harvesting group (44 cases),which used double cavity of femoral vein catheter for autologous peripheral blood stem cell collection.The observation indicators included venous ac-cesses,collection efficiency,patient tolerance,the number of mononuclear cell and CD34 positive cells.Results The numbers of mononuclear cells and CD34 positive cells in two groups were all above the standard and there was no significant differ-ence (P >0.05).However,the success of venous accesses,the efficiency smooth of collection and-patient tolerance were bet-ter in double cavity of femoral vein catheter group (P <0.05).Conclusion Harvesting the autologous peripheral blood stem cell through central venous by using double cavity of femoral vein catheter had the advantages as follows:high success rate of puncture,acquisition smoothly and reducing the suffering extent of the patients,and also it did not affect the acquisition effi-ciency and effectiveness.

Aim To investigate the role of autophagy and its mechanism in Raji cell death induced by arse-nic trioxide. Methods Transmission electron micros-copy ( SEM) and MDC fluorescence staining were used to observe autophagy. MTT colorimetry was employed to assay the cellular proliferating activity. Cell apopto-sis and cell cycle analysis were performed using FITC-Annexin-V/PI double staining and flow cytometry ( FCM) . The expressions of LC3 and the conversion of LC3-I to LC3-II were measured by western bloting. The expression of bcl-2 mRNA and p53 mRNA were detected by reverse transcription-polymerase chain re-action ( RT-PCR ) . Results Arsenic trioxide could obviously inhibit the proliferation of Raji cells, arrest the cells at G2/M phase and induce apoptosis. Mean-while, arsenic trioxide markedly inhibited the expres-sion of bcl-2 mRNA and enhanced the expression of p53 mRNA in Raji cells. Arsenic trioxide also induced autophagy synchronously which paralleled with the in-duction of apoptosis in Raji cells, and 3-MA, an auto-phagy inhibitor, was able to reverse the arsenic triox-ide-activated autophagic activity, up-regulate bcl-2, down-regulated p53 expression and suppress the lethal effect of arsenic trioxide on Raji cells to reduce their sensitivity to arsenic trioxide. In contrast, the Rapamy-cin, an autophagy inducer, possessed the completely opposite effects on Raji cells compared with 3-MA. Conclusions The apoptosis and autophagic cell death are coexistent in arsenic trioxide-triggered death of Raji lymphoma cells, and Bcl-2 and p53 may play a key regulating role in this process.

With the organic combination of rapid on-site evaluation (ROSE) and interventional pulmonary diagnostic technology, we can build a complete The System of Diagnostic Interventional Pulmonology Based on Rapid on-site Evaluation. With the help of ROSE, changing the ways, methods and modalities of interventional pulmonary diagnostic technology to obtain the target lesions is the core of this system. In this statement, the most commonly used standard operating techniques in The System of Diagnostic Interventional Pulmonology Based on Rapid on-site Evaluation are described in detail, including double-hinge curette operating technique, transbronchial lung biopsy (TBLB) technique, and transbronchial brushing technique.

Objective To observe the impact of improving the compliance of ventilator bundle on morbidity of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients undergoing mechanical ventilation (MV) guided by context of Joint Commission International (JCI) settings, and to study the oral care efficacy of suction tube sponge brush. Methods A prospective study was conducted. The patients who needed MV admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2013 to December 2016 were enrolled. In the context of JCI settings, necessary measurements were taken to enhance the compliance of ventilator bundle each year. In 2013, the preventive measures were set up and the education was strengthened. In 2014,the compliance of hand hygiene and bedside elevation was strengthened. In 2015, a control study was conducted to evaluate the effect between the traditional cotton dipped in chlorhexidine and the suction tube sponge brush rinsed with chlorhexidine on oral health impact parameters. The suction tube sponge brush rinsed with chlorhexidine oral care was introduced to improve compliance. In 2016, electronic bundle checklist for daily self-audits was conducted. The annually morbidity of VAP through the software of hospital and ICU was collected and calculated. The annual incidence of VAP was indicated by the VAP cases per 1000 MV days. Based on the VAP incidence rate in 2013 as 1, the VAP incidence-rate ratio (IRR) of each year was calculated. Results During the study period, a total of 2733 patients admitted to the ICU, including 1403 patients undergoing MV. Ninety-four of the 1403 patients with community-acquired pneumonia (CAP), aspiration pneumonia, back elevation ban, incomplete information, and withdrew from the study were excluded. 1399 patients undergoing MV were enrolled in the final analysis, with total MV days of 11012 days, and 94 patients occurred VAP. The annual incidence of VAP was progressively declined from 2013 to 2016, and the VAP cases per 1000 MV days were 17.0, 10.0, 5.9, 3.5 cases, respectively. Based on the VAP incidence rate in 2013, the IRR of VAP from 2014 to 2016 was also progressively declined, which was 0.59 [95% confidence interval (95%CI) = 0.35-0.98], 0.35 (95%CI = 0.18-0.64), and 0.21 (95%CI = 0.09-0.41), with statistical significance (all P < 0.05). In 2013, ICU patients had the lowest rates of bedside elevation and hand hygiene compliance, which were 28.57% and 54.29%, respectively. Compared with 2013, by the implementation of two quality control circle (QCC) projects for bedside elevation and hand hygiene, the rates of bedside elevation and hand hygiene compliance were improved significantly in 2014, which were 82.35%, 91.18%, respectively (both P < 0.05). In 2015, the compliance of chlorhexidine oral care which was the worst performed in 2014 had been improved by the method of QCC, and the rate of the compliance was significantly higher than that in 2013 (87.10% vs. 62.86%, P < 0.05). Compared with 2013, bundle compliance was significantly increased in 2016, except for the sterile operation of the suction tube [daily wake and weaning: 95.00% vs. 71.43%, bedside elevation for over 30°: 92.50% vs. 28.57%, hand hygiene: 97.50% vs. 54.29%, chlorhexidine mouth care once per 6-8 hours:95.00% vs. 62.86%, turned back and posture drainage: 97.50% vs. 80.00%], the differences were statistically significant (all P < 0.05). The incidences of bad breath, dirt residue and plaque were significantly lower in the group of oral care by using suction tube sponge brush with chlorhexidine (30 cases) compared with the group of traditional cotton pad with chlorhexidine (30 cases; bad breath: 10.0% vs. 40.0% %, dirt residue: 16.7% vs. 70.0%, plaque: 3.3% vs. 30.0%, all P < 0.05). There was no significant difference in the incidence of oral ulcers between the oral brush group and the traditional group (10.0% vs. 30.0%, P > 0.05). Conclusion Ventilator bundle can effectively reduce the morbidity of VAP in the context of JCI settings, and the oral care by using suction tube sponge brush and chlorhexidine can effectively improve oral hygiene.

Objective To explore the influence of intravenous injection combined with oral of metoprolol tartrate on left ventricular function and adverse cardiovascular events of patients with acute anterior myocardial infarction.Methods84 cases of Patients with acute anterior myocardial infarction treated in the First Hospital of Hebei Medical University were selected as the study objects, and were divided into vein group and combination group according to drugs-taking modes, 42 cases in each groups.The vein group were treated with intravenous injection of metoprolol tartrate, and the combination group were treated with intravenous injection combined with oral of metoprolol tartrate.Clinical effect, left ventricular function, BP and HR levels, and incidence of adverse cardiovascular events were observed in the two groups.ResultsThe total effective rate of the combination group was 95.24% significantly higher than that of 80.95% in the vein group(P<0.05).After treatment, LVEF was significantly higher than that before treatment in the two groups (P<0.05), which of the combination group was significantly higher than that of the vein group (P<0.05).The levels of LVESD and LVEDD were significantly lower than those before treatment in the two groups (P<0.05), which of the combination group were significantly lower than those in the vein group(P<0.05).After treatment, DBP, SBP and HR were significantly lower than those before treatment in the two groups (P<0.05), which of the combination group were significantly lower than those in the vein group(P<0.05).The incidence of adverse cardiovascular disease was 11.90% in the combination group, and it was no significantly different from that of 16.67% in the vein group (P>0.05).ConclusionIntravenous injection combined with oral of metoprolol tartrate can effectively improve left ventricular function of patients with acute anterior myocardial infarction, and reduce incidence of adverse cardiovascular events.

BACKGROUND:The incidence of intestinal necrosis during liver transplantation is low, and most of them abandon transplantation and thus leading to death. OBJECTIVE:To retrospectively analyze the reasons which result in smal intestinal necrosis during liver transplantation, and to explore the viable treatment options. METHODS:The clinical data of 207 patients were reviewed, two patients complicated with smal intestinal necrosis during liver transplantation. Case 1 underwent liver transplantation combined with necrotic smal bowel resection. Case 2 abandoned liver transplantation, and received conservative treatment. RESULTS AND CONCLUSION:Both of the two patients had preoperative portal system thrombosis. In Case 1, there was upper gastrointestinal bleeding before transplantation, and repeated application of hemostatic drugs could increase the thrombosis and thus resulting smal intestinal necrosis. At 10 days after liver transplantation, the patients complicated with intestinal fistula and were treated with fistulation. After fistulation, the patient suffered from abdominal cavity and lung infections. At 7 days after anti-infection treatment and immunosuppressant stopped, the infections were cured. At 40 days after fistulation, the intestinal fistula was healed and the patient was discharged after rehabilitation. After fol owed-up for 2 years, the patient was stil healthy living. The Case 2 suffered with mass ascites which lead to abdominal compartment syndrome, the intestinal venous disorders lead to extensive smal bowel necrosis. At 2 days after abandon the liver transplantation, the patient was dead because of multiple organ failure. The patients who waiting for liver transplantation had preoperative portal system thrombosis, abdominal pain and abdominal distention, should be pay attention to intestinal necrosis. Patients with smal bowel necrosis during liver transplantation can be cured with liver transplantation combined with necrotic smal bowel resection.

non-myeloablative BuCy+fludarabine conditioning regimen,and another one was treated with TBI+VP-1 6 +CTX+CCNU conditioning regimen.Only one case received short-term MTX,cyclosporin A and ATG regimen for prevention of graft-versus-host disease (GVHD).The GVHD prevention regimens of the other patients were based on short-term MTX,cyclosporin A,ATG and mycophenolate mofetil regimen.The hematopoietic reconstitution, complications and prognosis were observed.Results One patient died of intracranial hemorrhage,and hematopoi-etic reconstitution was achieved in the other 20 patients.The median time for hematopoietic reconstitution shortened by one day in large-dose group compared with that in low-dose group.Adverse reactions included high fever, shivering,gastrointestinal tract adverse reaction,liver injury,oral mucositis and other rare side effects.GVHD occurred more frequently in patients with HLA mismatched transplantation.Nine patients with aGVHD and 9 patients with cGVHD recovered after effective treatment.Within 100 days after transplantation,18 patients had bacterial or fungal infection,mainly upper respiratory tract infection;7 patients had cytomegalovirus infection;2 had EB viremia,and one had urinary BK virus infection.Only one patient died of VOD.Hemorrhagic cystitis occurred in 5 patients and improved after treatment.The median survival time was 24 months (ranging from 136 days to 9 years).One-year and 3-year overall survival rates were 85.2% and 63.9%,the disease free survival rates were 81% and 23.8%,recurrence free survival rates were 71.4% and 14.3%,respectively.Conclusion URD-HSCT was an effective method to treat leukemia.Conditioning regimen of BuCy and modified BuCy2 were safe and effective,the adverse reactions were reversible and well tolerated.Hematopoietic reconstitution time shortened in large-dose MNC and CD34 + cell number groups compared with that in low-dose group.The occurrence rate of GVHD with HLA mismatched transplantation was more than that of HLA matched transplantation.Low-dose heparin,prostaglandin E1 and Danshen injection can effectively prevent VOD.