Objective To observe the clinical therapeutic effect of oral solution of Huaixue Shenshu for treatment of patients with IgA nephropathy and explore its mechanism. Methods A prospective study was conducted. Forty patients with IgA nephropathy diagnosed by pathology were selected, and they were randomly divided into treatment group and control group, 20 cases in each group. The two groups were subjected to the routine treatment, and on this base, the control group also received cozaar 50-100 mg, while the treatment group additionally received oral solution of Huaixue Shenshu decoction (drug composition:Centellae herba 15 g, Sophorae Flos 20 g, Ecliptae Herba 20 g, Ligustri Lucidi Fructus 15 g, Cicadae Periostracum 15 g, Pyrolae Herba 20 g, Saposhnikoviae Radix 10 g, Astragali Radix 15 g, the above ingredients were immersed in water and boiled to form 200 mL decoction, as a dose, and then divided into two parts to take orally one of them each time, twice a day). Both groups took two therapeutic courses in total, 3 months constituting one course. After treatment, the integral changes of clinical symptoms and clinical efficacy were observed, and before treatment and 3 months and 6 months after treatment, the 24-hour urine protein, serum creatinine (SCr), and albumin (Alb) were measured in the two groups. Results Before treatment, there was no significant difference in integral of clinical symptoms between treatment group and control group (score: 18.42±5.41 vs. 19.95±6.25, P>0.05);after treatment, the integrals of two groups were significantly lower than those before treatment, and the degree of decrease in treatment group was more obvious (score: 6.35±2.11 vs. 9.45±3.55, P < 0.05). After treatment the total effective rate in treatment group was significantly higher than that in control group [75.0% (15/20) vs. 40.0% (8/20), P<0.05]. Before treatment, the differences in 24-hour urinary protein, SCr and Alb were not significant between the two groups (all P > 0.05); with the prolongation of treatment, the 24-hour urinary protein was decreased gradually, and Alb was increased gradually, reaching its peak after 6 months of treatment, and the changes were more obvious in treatment group [24-hour urinary protein (g):0.71±0.58 vs. 1.31±0.55, Alb (g/L):37.8±6.1 vs. 35.5±5.2, both P<0.01]. No significant difference in SCr was found before and after treatment between the two groups (both P > 0.05). Conclusion The effect of oral solution of Huaixue Shenshu in treatment of IgA nephropathy is good.

Abstract： Objective　To retrospectively analyze the investigation and disposal of the COVID-19 outbreak caused by the transmission of the Omicron variant in infected imported cases, and provide basis for COVID-19 outbreak management. Methods　The description epidemiological method was used to describe the COVID-19 outbreak in Sanya City from March 31 to April 15, 2022. The propagation chain was mapped and the experience gained and shortcomings identified in emergency responses were analyzed. Results　The outbreak resulted in 95 reported locally transmitted COVID-19 cases with a incubation period M(P25, P75) of 4 (3, 5) d. In the 95 cases, the proportion of cases detected through close contact screening, centralized isolation, community screening, control area screening, active treatment (examination), and key population screening were 33.68%, 22.11%, 18.95%, 12.63%, 6.32%, 4.21% and 2.11%, respectively. The epidemic spread for 6 generations, causing 5 clusters of outbreaks and 12 cases of cluster disease. The epidemic affected 12 villages/neighborhood committees, 1 bar, 1 hospital, 1 small clinic, 1 farmer's market, 1 large shopping mall and 1 restaurant in 2 districts of Sanya City. The result of gene sequencing was Omicron variant BA.1.1. Through the immediate launch of emergency plans, nucleic acid and antigen testing, controlling close contact between infected persons and close contacts, suspending indoor business sites, central urban control, and temporary suspension, COVID-19 was controlled within 16 days. Conclusions　The transmission chain of this outbreak was clear and was caused by imported cases. Strengthening the management of the pass, doing a good job in information sharing and docking, timely screening for cases, screening, pushing, controlling high-risk groups, and implementing comprehensive control measures, can effectively prevent the spread of the epidemic, providing a reference for the control of epidemic situations in relevant scenarios.

Objective To explore the efficacy of electroacupuncture and massage combined with Yaobi-Zhuyu-Zhitong decoction in the treatment of lumbar disc herniation (LDH). Methods A total of 100 LDH patients with qi stagnation and blood stasis type who met the inclusion criteria were randomly divided into two groups, 50 in each group. The control group was treated with Yaobi-Zhuyu-Zhitong decoction, and the observation group was treated with electroacupuncture and massage on the basis of the control group. Both groups were treated for 4 weeks. The VAS scale was used to evaluate the degree of pain. The Japanese Orthopedic Association Scores (JOA) was used to evaluate the efficacy of low back pain. The Oswestry dysfunction index was used to evaluate the recovery of lumbar function, and the improvement of daily activities of patients after treatment was evaluated.Results After treatment, the VAS score of the observation group was significantly lower than that of the control group, and the JOA score was significantly higher than that of the control group (t value were 9.870, 8.214, P<0.01). The excellent and good rates of Oswestry dysfunction index before and after treatment in the observation group were 34.0％ (17/50) and 86.0％ (43/50), respectively, and the control group was 24.0％ (12/50) and 44.0％(22/50), respectively. The excellent rate of Oswestry dysfunction index in the two groups was significantly higher than that in the same group before treatment (χ2 values were 28.167, 4.456, P<0.01), and the observation group was significantly higher than the control group (χ2=19.385, P<0.001). The scores of daily activities such as walking, weight-bearing, sitting for a long time, bending over, washing, standing, sleeping and turning over in the observation group were significantly higher than those in the control group (t values were 3.689, 1.661, 3.621, 3.621, 3.300, 1.661, 1.461 respectively, all Ps<0.05). The total effective rate was 94.0％ (47/50) and the control group was 76.0％ (38/50). The difference between the two groups was statistically significant (χ2=6.353, P=0.012). Conclusions Electroacupuncture and massage combined with Yaobi-Zhuyu-Zhitong decoction can improve the lumbar function, reduce the degree of lumbar pain, improve the quality of life of the LDH patients with qi stagnation and blood stasis type.

Objective To investigate the effect of dexmedetomidine on the incidence of POCD and the inflammatory response of central nervous system in elderly patients with radical gastrectomy,so as to provide reference for the selection of POCD prophylaxis in elderly patients.Methods A total of 86 elderly patients aged 36-79 years with ASA grade Ⅰ-Ⅲ underwent radical gastrectomy with general anesthesia were enrolled.They were randomly divided into two groups using computer random software:dexmedetomidine group (D group) and saline group (S group),43 patients in each group.MMSE score and MoCA score were recorded 1 day before anesthesia (T0),6h after operation (T1),24h after operation (T2) and 48h after operation (T3).Interleukin-1β (IL-1β),interleukin -6 (IL-6) and C-reactive protein (CRP) were measured at different time points.The incidence of hypotension and bradycardia was recorded.Results There were no significant differences in MMSE scores and MoCA scores between the two groups 1 day before anesthesia (t =0.356,0.403,all P ＞0.05).The MMSE score and MoCA score of the D group were significantly higher than those of the S group at T1,T2 and T3 (t =5.998,6.886,5.943,6.180,6.947,7.151,all P ＜0.05).The levels of IL-1β,IL-6 and CRP in the D group were significantly lower than those in the S group at T1,T2 and T3 (t =2.239,2.731,2.134,15.47,17.28,12.93,4.583,6.444,7.544,all P ＜ 0.05).Conclusion Dexmedetomidine can significantly reduce the risk of POCD in elderly patients with radical gastrectomy,and can inhibit the inflammatory response.It is worth to use in clinic.

Objective:To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods:Through retrospective analysis, diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine, Quanzhou First Hospital East Street Branch Area, affiliated to Fujian Medical University between January to June 2021.Results:Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years, with various underlying diseases such as coronary heart disease, chronic heart failure, chronic obstructive pulmonary disease, etc.All patients had an established history of poultry exposure.These cases had high fever, cough, spitting, and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The disease progressed rapidly, with severe respiratory failure, acute kidney injury, and shock appearing soon, accompanied by different degrees of muscle injury, and damage to the heart, liver, blood coagulation, and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased: at 3, 5, 7 d after admission, the level of C reactive protein was 214.6(153.9-256.3)mg/L, 199.2(115.8-333.8)mg/L, 151.0(11.19-173.7)mg/L, respectively; and interleukin 6 level was 1 241.0(912.1-6822.0)ng/L, 779.1(451.2-7122.0)ng/L, 631.2(7.0-4 321.0)ng/L, respectively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground-glass shadows spreaded to both lungs, may accompany the miliary and nodular shadows, and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next-generation sequencing(mNGS), mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease, advanced age, underlying diseases, and timely diagnosis and effective treatment.Conclusions:The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age, more basic diseases such as chronic cardiopulmonary disease, smoking, and timely diagnosis and treatment.Generally, laboratory and imaging examinations have no diagnostic specificity, but mNGS is of great significance for early diagnosis, transition to target treatment and improvement of prognosis.

BACKGROUND: Previous research demonstrated that a homozygous mutation of g.136372044G>A (S12N) in caspase recruitment domain family member 9 ( CARD9 ) is critical for producing Aspergillus fumigatus -induced ( Af -induced) T helper 2 (T H 2)-mediated responses in allergic bronchopulmonary aspergillosis (ABPA). However, it remains unclear whether the CARD9S12N mutation, especially the heterozygous occurrence, predisposes the host to ABPA. METHODS: A total of 61 ABPA patients and 264 controls (including 156 healthy controls and 108 asthma patients) were recruited for sequencing the CARD9 locus to clarify whether patients with this heterozygous single-nucleotide polymorphisms are predisposed to the development of ABPA. A series of in vivo and in vitro experiments, such as quantitative real-time polymerase chain reaction, flow cytometry, and RNA isolation and quantification, were used to illuminate the involved mechanism of the disease. RESULTS: The presence of the p.S12N mutation was associated with a significant risk of ABPA in ABPA patients when compared with healthy controls and asthma patients, regardless of Aspergillus sensitivity. Relative to healthy controls without relevant allergies, the mutation of p.S12N was associated with a significant risk of ABPA (OR: 2.69 and 4.17 for GA and AA genotypes, P = 0.003 and 0.029, respectively). Compared with patients with asthma, ABPA patients had a significantly higher heterozygous mutation (GA genotype), indicating that p.S12N might be a significant ABPA-susceptibility locus ( aspergillus sensitized asthma: OR: 3.02, P = 0.009; aspergillus unsensitized asthma: OR: 2.94, P = 0.005). The mutant allele was preferentially expressed in ABPA patients with heterozygous CARD9S12N , which contributes to its functional alterations to facilitate Af -induced T H 2-mediated ABPA development. In terms of mechanism, Card9 wild-type ( Card9WT ) expression levels decreased significantly due to Af -induced decay of its messenger RNA compared to the heterozygous Card9S12N . In addition, ABPA patients with heterozygous CARD9S12N had increased Af -induced interleukin-5 production. CONCLUSION Our study provides the genetic evidence showing that the heterozygous mutation of CARD9S12N , followed by allele expression imbalance of CARD9S12N , facilitates the development of ABPA.
Humans ; Aspergillosis, Allergic Bronchopulmonary/complications* ; Aspergillus fumigatus/genetics* ; Asthma/genetics* ; Aspergillus ; Mutation/genetics* ; CARD Signaling Adaptor Proteins/genetics*