Objective To evaluated the effectiveness and safety ofLianhua Jizhi Tablets for acute trachitis and bronchitis with syndrome of phlegm-heat obstructing.Methods A randomized double-blind, placebo-controlled and multi-center clinical trial design was selected. Totally 240 cases were randomly divided into experimental group and control group, 120 cases in each group, of which 237 cases were included in the analysis of FAS. Experimental group was givenLianhua Jizhi Tablets, while control group was given placebo, 12 tablets/day, 7 days for a course. Curative effect of acute trachitis and bronchitis, TCM syndrome and disappearance of cough, cough and sputum symptom scores and area under the curve (AUC) were observed. The safety was evaluated. Results The cure rates of disease in experimental group and control group were 66.67% (78/117) and 29.17% (35/120), respectively;cure rates of TCM syndrome in experimental group and the control group were 68.38% (80/117) and 27.50% (33/120), respectively;there was statistically significant difference in area under the curve of cough and sputum symptom score between the two groups (P<0.01). Disappearance rates (cure) of daytime cough in experimental group and control group were 52.99% (62/117) and 13.33% (16/120), respectively;disappearance rates (cure) of nocturnal cough in experimental group and control group were 76.52% (88/115) and 31.90% (37/116), respectively;there were no side effects in experimental group.ConclusionLianhua Jizhi Tablets can significantly relieve clinic symptoms in the treatment of acute trachitis and bronchitis, and have good clinical efficacy and safety.

Objective To assess the variation of sexual hormone and mechanisms of low testosterone in young male obesity with acanthosis nigricans. Methods Retrospective analysis was performed in 125 male obesity patients [ body mass index( BMI)≥28 kg/m2 ] . According to their clinical characteristics, they were divided into two groups including obesity without acanthosis nigricans(OB group, n=62) and obesity with acanthosis nigricans(AN group, n=63). 60 normal weight men were also recruited as a control group. Body fat and body weight were measured. Blood insulin, lipid profile, sex hormones levels, and inflammation factors were measured. Parameters of each group were compared and the correlations between total testosterone level and other index were analyzed. Results All the male obesities have the significant lower total testosterone levels than those of control group(P>0. 05), and those in AN group were lower than those in OB group(P>0. 05). The BMI and body fat in OB group and AN group were both significantly higher than those in control group(P>0. 05). The fasting insulin levels in all obese men were significantly higher than those in control group(P>0. 05), highest in AN group. Triglycerides(TG) in both OB and AN group were higher than those in controls, and not significant between later 2 groups. But high-density lipoprotein-cholesterol ( HDL-C) in the two groups were significantly lower than control, which in AN group were significantly lower than OB group. Total testosterone levels in AN group were negatively correlated with weight, waist circumference, hip circumference, fasting insulin, and homeostasis model assessment for insulin resistance ( HOMA-IR ) , and also negatively correlated with inflammation factors including C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR) , tumor necrosis factor-α( TNF-α) , and uric acid. However, total testosterone levels in AN group were not correlated with lipid metabolism index. Conclusion Young male obesity with acanthosis are associated with secondary hypogonadism. Hyperinsulinemia, insulin resistance, and inflammatory factors are risk factors for the occurrence of this secondary male hypogonadism.

Objective To explore the association between test results of human biological stimulation feedback instrument (EZSCAN) and blood glucose levels. Methods Data were collected from the general population who received health checkups that included examination of the autonomic nervous system function using the EZSCAN human biological stimulation feedback instrument from January to December 2017 in Shanghai Eastern Hospital. In accordance with the inclusion and exclusion criteria, 2136 cases (1122 men and 1024 women), with an average age of (50.7 ± 12.9) years, were enrolled in the final analysis. Participants were divided according to the diabetic risk scores obtained by EZSCAN into the control group (n=784 cases), low-risk group (n=801 cases), and high-risk group (n=551 cases). Fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) levels were statistically compared between groups. Participants were divided into four groups according to FPG quartiles [Group F1 (FPG≤4.76 mmol/L, n=546 cases), Group F2 (4.76 mmol/L5.58 mmol/L, n=528 cases)] and HbA1c quartiles [Group H1 (HbA1c≤5.3％, n=630 cases), Group H2 (5.3％5.9％, n=457 cases)]. EZSCAN test results were compared between the quartile groups. Correlations between EZSCAN results and FPG levels and HbA1C levels were analyzed. Results There were statistical differences in both FPG levels and HbA1c levels between participants in the control group, low-risk group, and high-risk group [FPG: (5.10 ± 1.06) mmol/L, (5.47 ± 1.36) mmol/L, and (5.59 ± 1.32) mmol/L, respectively, F=29.47, P<0.05; HbA1C:(5.95 ± 0.99)％, (5.79 ± 0.89)％, and (5.50 ± 0.70)％, respectively, F=47.42, P<0.05]. With increases in both FPG and HbA1C quartile levels, the EZSCAN scores showed a statistically increasing tendency [Groups F1-F4:(30.1 ± 14.6), (32.9 ± 15.2), (33.8 ± 15.1), and (39.1 ± 15.6), F=32.98, P<0.05;Groups H1-H4: (29.1 ± 14.4), (31.9 ± 14.2), (37.2 ± 15.3), and (40.3 ± 15.8), F=61.36, P<0.05]. Both FPG and HbA1c levels were positively correlated with diabetic risk scores (r=0.22 and 0.32, P<0.05). Conclusion Test results using the EZSCAN human biological stimulation feedback instrument showed significantly positive correlations with blood glucose levels.

Objective:To explore the tricuspid annular plane systolic excusion(TAPSE) in children with left-to-right shunt after congenital heart disease surgery and to understand the early systolic function of right heart in thesepatient.Methods:From June 2018 to December 2018, a prospective study was conducted in 20 infants after repair of left-to-right shunt congenital heart disease, including 10 males(50%) and 10 females(50%) , aged from 1 to 12 months, with a median of 4.5(2.0, 6.8) months, a body mass of 3.0-9.0 kg with median of 6.0(3.7, 7.7) kg.On the first postoperative day, blood was taken from central venous for N-terminal pro-B-type natriuretic peptide(NT pro-BNP) test, TAPSE and left ventricular ejective fraction(LVEF) was measured by echocardiography.The effects of aortic occlusion time, cardiopulmonary bypass time, preoperative pneumonia and preoperative heart failure on TAPSE were compared. The relationship between TAPSE and heart rate, systolic pressure, central venous pressure, vasoactive drug score, endotracheal intubation time, detention time in intensive care unit, NT pro-BNP and LVEF after operation was analysed.Results:The aortic cross-clamping time was 15-87 minutes, with median 31(28, 50) minutes. The cardiopulmonary bypass time was 35-117 minutes, with an average of(68±22)minutes. The time of tracheal intubation was 4-117 hours, with an average of(50±35) hours. The stay time in CICU was 1-14 days, with a median of 5(2, 7) days.The LVEF was 0.18-0.66, with median 0.53(0.42, 0.57). The TAPSE was 2.0-10.0 mm, with an average of(5.2±2.0) mm. On the first day after operation, NT pro-BNP was 1 548-35 000 pg/ml, with an average of(9 446±8 130) pg/ml.TAPSE was negatively correlated with postoperative intubation time( r=-0.576, P= 0.007) and detention time in ICU( r=-0.765, P=0.000), and positively correlated with postoperative LVEF( r=0.461, P=0.041)( P<0.05). TAPSE was negatively correlated with heart rate( r=-0.303, P=0.193), central venous pressure( r=-0.425, P=0.062), vasoactive drug score( r=-0.418, P=0.067) and NT Pro BNP( r=-0.348, P=0.132), and positively correlated with systolic pressure( r=0.146, P=0.54), but there was no statistical significance in each item.Compared with patients with TAPSE≥5mm, the detention time and tracheal intubation time were longer than those TAPSE<5 mm, the central venous pressure and NT-pro BNP was higher than those TAPSE<5 mm( P<0.05), the difference was statistically significant, other indicators had no significant difference. Conclusion:It is simple and feasible to measure TAPSE by echocardiography in children after operation with left-to-right shunt congenital heart disease.TAPSE decreased postoperatively suggested that the function of right ventricle decreased at the early stage after surgery, and with left ventricle systolic function decreased, which eventually led to the increase of NT pro-BNP, the need for higher doses of vasoactive drug support, longer tracheal intubation time and the stay time in CICU.Attention should be paid to the right heart function of children after congenital heart surgery.

OBJECTIVETo assess the effects of laparoscopic sleeve gastrectomy (LSG) on insulin secretion mode and metabolism of glucose and lipid in morbidly obese patients.

METHODSClinical data of 65 morbidly obese patients [body mass index (BMI) ≥30 kg/m] undergoing LSG at Shanghai 10th People's Hospital from August 2012 to December 2016 were retrospectively analyzed. According to the result of OGTT, these obese patients were divided into three groups: normal glucose tolerance (NGT, 23 cases), impaired glucose tolerance (IGT, 22 cases) and type 2 diabetes mellitus (DM, 20 cases) groups. Twenty-two healthy people [BMI (23.1±1.4) kg/m] were used as control group. The anthropometries parameters [weight, BMI, waist circumference, body fat percentage, excess weight loss(%EWL)], glucose metabolic indices [fasting plasma glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), homeostasis model assessment-insulin resistance index (HOMA-IR)], lipid profile (TC, TG, HDL-C, LDL-C) and inflammatory factor (UA, TNF-α) of 3 groups were detected before operation and at postoperative 1-, 3-, 6-month. These variables were analyzed among morbidly obese groups before and after surgery and compared to control group. Clinical registration number of this study was ChiCTROCSl2002381.

RESULTSBody weight, waist circumference and BMI of morbidly obese patients all decreased at postoperative 1-, 3-, 6-month. Postoperative %EWL increased obviously to (71.5±24.7)% with the highest range in DM group. Percentage of successful weight loss (%EWL>50%) in NGT, IGT and DM groups was 63.6%, 83.9% and 90.0% at postoperative 6-month respectively, and DM group was also the highest. At postoperative 6-month, HbA1c of 3 morbidly obese groups became normal; FPG and postprandial 2-hour glucose of IGT and DM group decreased to normal level; insulin level of 3 morbidly obese groups decreased obviously compared to pre-operation (all P<0.05), especially FINS and postprandial 2-hour insulin became normal without significant difference of control group (P>0.05), while postprandial 30-minute and 60-minute insulin levels in 3 groups were still higher as compared to control group. The insulin secretion curves of morbidly obese groups showed hyperinsulinemia before surgery. The peak of insulin secretion curve in IGT and DM group moved back to postprandial 120-minute before operation, and returned to 60-minute after operation, with basic normal rhythm of secretion curve. Preoperative HOMA-IR in all 3 morbidly obese groups was higher than that in control group (all P<0.05) and remarkably lower at postoperative 6-month compared to pre-operation(P<0.05). In 3 morbidly obese groups after operation, TG decreased, HDL-C increased, UA and TNF-α decreased significantly compared to before operation (all P<0.05). At postoperative 6-month, the HOMA-IR of DM group was positively correlated with BMI (r=0.236, P=0.004) and TNF-α (r=0.228, P=0.033), and was not correlated with HDL-C(P>0.05).

CONCLUSIONSLSG can effectively ameliorate hyperinsulinemia and insulin secretion curve, and improve metabolic disorder and insulin resistance of different stage in obesity patients with glucose metabolic disorder. Insulin resistance is correlated with body weight and inflammatory factors.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.