Objective To observe the clinical curative effects of Changwei Shu combined with conventional western medicine therapy in treating the sepsis patients with gastrointestinal dysfunction.Methods A total of 120 cases of sepsis patients with gastrointestinal dysfunction were randomly divided into treatment group and control group,60 patients in each group.The control group was given conventional western medicine therapy,and the treatment group was given Changwei Shu combined with conventional western medicine therapy.After treatment for 7 days,the clinical efficacy and safety were evaluated by observing the changes in white blood cell (WBC) count,procalcitonin (PCT) level,intra-abdominal pressure (IAP),gastrointestinal dysfunction scores,and scores of acute physiology and chronic health evaluation (APACHE Ⅱ).Results (1) For one case dropped out and one was excluded from the treatment group,and 4 cases dropped out and 2 were excluded from the control group,a total of 58 cases in the treatment group and 54 in the control group were included into the study at the end of the trial.(2) The total effective rate of the treatment group was 91.38％ and that of the control group was 88.89％,the difference being significant (P ＜ 0.05).(3) After treatment,WBC count,PCT level and IAP of the two groups were improved (P ＜ 0.01 compared with those before treatment),and the improvement of the treatment group was superior to that of the control group (P ＜ 0.01).(4) After treatment,gastrointestinal dysfunction scores and APACHE Ⅱ scores of the two groups were decreased(P ＜ 0.01 compared with those before treatment),and the decrease of the treatment group was superior to that of the control group (P ＜ 0.01).(5) During the treatment,4 cases from the treatment group had nausea,and 5 cases from the control group had nausea and abdominal distention,and the symptoms disappeared spontaneously one week later.No obvious changes were found in the hepatic and renal function of the two groups.Conclusion Changwei Shu exerts an effect on reducing the inflammation,improving the gastrointestinal function,and relieving the illness severity of sepsis patients with gastrointestinal dysfunction.

ObjectiveTo study the anti-inflammatory effect of traditional Chinese medicine (TCM) Changweishu on sepsis patients with gastrointestinal dysfunction and its protective effect on intestinal mechanical barrier.Methods A prospective research method was conducted. Fifty sepsis patients with gastrointestinal dysfunction admitted into Department of Emergency Intensive Care Unit (EICU) of Hebei Provincial TCM Hospital from October 2013 to June 2015 were enrolled, and they were divided into a conventional treatment of western medicine control group and a TCM Changweishu group according to the random number table method, 25 cases in each group. The conventional western medicine treatment was given to both groups, and in TCM Changweishu group, additionally Changweishu 1 dose per day, a mixture of following ingredients constituting one dose without decoction, was applied, including: rhubarb 9 g, dandelion 20 g, green tangerine peel 15 g, angelica sinensis radix 15 g, red and white peony each 12 g, rhizome ligusticum 9 g, agrimony 20 g, coptidis rhizoma 6 g, rhizoma pinelliae 6 g, fructus trichosanthis 15 g, garden burnet root 20 g, poria 20 g, and taken once 1/2 dose in the morning and once 1/2 dose in the evening by oral or nasal feeding. After treatment for 7 days, the level changes of inflammatory factors of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), high mobility group protein B1 (HMGB1) and gastrointestinal dysfunction indexes of diamine oxidase (DAO), D-lactic acid in the two groups were observed.Results After treatment, the levels of TNF-α, IL-6, HMGB-1, DAO, D-lactic acid in the two groups were significantly lower than those before treatment [the western medicine control group: TNF-α (A value) 10.89±1.65 vs. 50.30± 1.58, IL-6 (A value) 7.35±1.85 vs. 12.66 ± 1.43, HMGB1 (A value) 5.28 ±1.64 vs. 6.23±0.95, DAO (A value) 5.87±0.59 vs. 6.67±0.49, D-lactic acid (A value) was 2.63±0.17 vs. 4.58±0.16; TCM changweishu group: TNF -α (A value) 5.38±1.19 vs. 51.23±2.34, IL-6 (A value) 5.54±1.26 vs. 13.24±1.78, HMGB1 (A value) 3.69±1.09 vs. 6.14±1.42, DAO (A value) was 3.39± 0.40 vs. 6.70±0.34, D-lactic acid (A value) 1.95±0.13 vs. 4.63±0.11, allP < 0.05]. After treatment, the degrees of decline in indexes of TCM Changweishu group were more obvious than those in western medicine control group [TNF-α(A value) 5.38±1.19 vs. 10.89±1.65, IL-6 (A value) 5.54±1.26 vs. 7.35±1.85, HMGB1 (A value) 3.69 ±1.09 vs.5.28±1.64, DAO (A value) 3.93±0.40 vs. 5.87±0.59, D-lactic acid (A value) 1.95±0.13 vs. 2.63±0.17, allP <0.05].Conclusions TCM Changweishu has protective effect on sepsis patients with gastrointestinal dysfunction, and its mechanisms are the amelioration of damage in intestinal tract mechanical barrier, decrease of permeability of intestinal mucosa and inhibition of levels of inflammatory factors.

Objective:To evaluate the clinical efficacy and safety of combination of traditional Chinese and Western medicine in the treatment of coronavirus disease 2019 (COVID-19) by Meta analysis.Methods:The clinical randomized controlled trials (RCT) and cohort studies on the treatment of COVID-19 with combination of Chinese traditional and Western medicine published on CNKI, Wanfang database, VIP database and PubMed were searched by computer from January 2020 to June 2020. Patients in the simple Western medicine treatment group were treated with routine treatment of Western medicine, and the patients in integrated traditional Chinese and Western medicine treatment group were treated with traditional Chinese medicine on the basis of routine treatment of Western medicine. The main outcome was the total effective rate of treatment. The secondary outcome were the antipyretic rate, chest CT recovery rate, lymphocyte count (LYM), C-reactive protein (CRP) level and safety. The Cochrane manual and the Newcastle Ottawa Scale (NOS) were used to evaluate the quality of the literature; the RevMan5.3 software was used to analyze the articles that meets the quality standards, and a funnel chart was drawn to evaluate the total effective publication bias.Results:Thirteen articles were analyzed, including 1 039 COVID-19 patients, 559 in integrated traditional Chinese and Western medicine treatment group and 480 in simple Western medicine treatment group. The results of Meta-analysis showed that compared with the simple Western medicine treatment group, the combination of routine treatment of Western medicine and traditional Chinese medicine Qingfei Paidu decoction, Lianhua Qingwen granule, Shufeng jiedu capsule, Xuebijing injection or Reyanning mixture could significantly improve the total effective rate, antipyretic rate and chest CT recovery rate [total effective rate: odds ratio ( OR) = 2.95, 95% confidence interval (95% CI) was 2.10-4.14, P < 0.000 01; antipyretic rate: OR =3.01, 95% CI was 1.64-5.53, P = 0.000 4; chest CT recovery rate: OR = 2.53, 95% CI was 1.83-3.51, P = 0.000 1], increase LYM levels [mean difference ( MD) = 0.26, 95% CI was 0.02-0.50, P = 0.03], and reduce of CRP content ( MD = -17.68, 95% CI was -33.14 to -2.22, P = 0.02). Based on the funnel chart analysis of 12 articles with total efficiency, the result showed that the funnel chart distribution was not completely symmetrical, indicating that there might be publication bias. Conclusions:On the basis of routine treatment with Western medicine, combined with traditional Chinese medicine can significantly improve the total effective rate of COVID-19 and improve the laboratory results and clinical symptoms of patients. Compared with the routine treatment of Western medicine alone, the combination of traditional Chinese and Western medicine has better clinical efficacy and safety.

Objective:In Shanghai Advanced Proton Therapy Facility (SAPT) of Ruijin Hospital Proton Therapy Center, the calculation accuracy of the commercial proton treatment planning system RayStation (V10), especially the accuracy of the proton range calculation, was measured and verified, aiming to provide reference for the clinical application of the treatment planning system.Methods:A head phantom was used to verify the calculation accuracy of RayStation. The phantom CT was imported into treatment planning system (TPS). The phantom was followed closely by a water tank with a one-liter cubic target. A single field verification plan with the prescribed dose of 200 cGy (relative biological effectiveness) was designed and implemented. Then, the measured distribution results were compared with the calculation results.Results:When the verification plan of the phantom was designed with the default settings of RayStation, the measured longitudinal dose distribution was approximately 4 mm deeper than that of TPS, indicating that RayStation overestimated the water equivalent thickness (WET) of the tissue substitute materials in the phantom. To study the range error, the actual beam was used to measure the WET of the soft tissue substitute material. The default setting of RayStation was fine-tuned according to the measured results. It was found that the error between the measured SOBP and TPS calculations was reduced to only 2 mm.Conclusions:Using the default setting of RayStation to calculate the stopping power of the phantom may cause a large range error. A method that combines tissue segmentation with the measured WET of the tissue substitute material is proposed to improve the range calculation accuracy of the TPS. The results show that the proposed method can improve the dose and range accuracy of the commercial TPS including RayStation for tissue substitute materials.

ABSTRACT:Objective To investigate the effect of clinical nursing pathway of Traditional Chinese medicine and western medicine in patients with diabetic peripheral neuropathy(DPN). Methods A total of 60 DPN patients were randomly divided into the path group and control group,clinical Toronto score,the change of EMG,the satisfaction degree of patients,the degree of knowledge of disease,length of stay and cost of hospitalization were compared before and after the implementation of clinical nursing.Results Through the comparison of observation index,the path group had significant curative effect than the control group.Conclusion Application of clini-cal nursing pathway of traditional Chinese medicine and western medicine can effectively improve the clinical symptoms of patients with DPN,delay the occurrence and development of DPN,im-prove the knowledge of the disease,and can shorten the length of hospital stay,improve the quality of life for patients.

ABSTRACT:Objective To investigate the effect of clinical nursing pathway of Traditional Chinese medicine and western medicine in patients with diabetic peripheral neuropathy(DPN). Methods A total of 60 DPN patients were randomly divided into the path group and control group,clinical Toronto score,the change of EMG,the satisfaction degree of patients,the degree of knowledge of disease,length of stay and cost of hospitalization were compared before and after the implementation of clinical nursing.Results Through the comparison of observation index,the path group had significant curative effect than the control group.Conclusion Application of clini-cal nursing pathway of traditional Chinese medicine and western medicine can effectively improve the clinical symptoms of patients with DPN,delay the occurrence and development of DPN,im-prove the knowledge of the disease,and can shorten the length of hospital stay,improve the quality of life for patients.

Objective : To investigate the influences of circ_WBSCR17 on high glucose-induced fibrosis and inflammation in human mesangial cells by regulating the miR-30a-5p /JAK1 axis． Methods : Human mesangial cells HMCL were grouped into : NG group (5．5 mmol / L glucose-treated HMCL cells) ，HG group (30 mmol / L glucose- treated cells) ，si-NC group (30 mmol / L glucose + transfected with si-NC) ，si-circ_WBSCR17 group (30 mmol / L glucose + transfected with si-circ _ WBSCR17 ) ，si-circ _ WBSCR17 + inhibitor-NC group ( 30 mmol / L glucose + co-transfected with si-circ_WBSCR17 and inhibitor-NC) ，and si-circ_WBSCR17 + miR-30a-5p inhibitor group (30 mmol / L glucose + co-transfected with si-circ_WBSCR17 and miR-30a-5p inhibitor) ; RT-qPCR was performed to detect the expression of circ_WBSCR17 and miR-30a-5p in cells ; CCK-8 assay was performed to detect cell prolifer- ation ; flow cytometry was performed to detect apoptosis ; ELISA was performed to detect the expression levels of tumor necrosis factor-α (TNF-α) ，interleukin (IL) -6 and IL-8 ; Western blot was performed to detect the expression of JAK1，proliferating cell nuclear antigen ( PCNA) ，Bax，transforming growth factor-β1 ( TGF-β1 ) ，fibronectin (FN) ，collagen IV，and α-smooth muscle actin ( α-SMA) ; distribution of WBSCR17 was detected by fluorescence in situ hybridization (FISH) ; dual-luciferase reporter gene experiment was performed to verify the relationship between circ _ WBSCR17 and miR-30a-5p，miR-30a-5p and JAK1，respectively. Results : Compared with the NG group，the HMCL cell proliferation ability of the HG group decreased，the levels of TNF-α , IL-6 and IL-8，the pro- tein expressions of p-JAK1 /JAK1，p-STAT1 / STAT1，p-STAT3 / STAT3，TGF-β1，FN，collagenIV and α-SMA，and the apoptosis ability increased (P＜0. 05) ; compared with HG group and si-NC group，the expression of miR-30a- 5p，OD450 value and PCNA expression in HMCL cells of si-circ_WBSCR17 group increased，the levels of TNF-α , IL- 6 and IL-8，the expressions of circ_WBSCR17，p-JAK1 /JAK1，p-STAT1 / STAT1，p-STAT3 / STAT3，Bax，TGF-β1， FN，collagenIV and α-SMA decreased ( P ＜0. 05 ) ; inhibition of miR-30a-5p attenuated the promoting effect of knockdown of circ_WBSCR17 on proliferation of HMCL cells，and enhanced apoptosis，cellular fibrosis and inflammatory responses ; FISH experiment confirmed that WBSCR17 was mainly distributed in the cytoplasm ; dual-luciferase reporter gene experiment confirmed that circ_WBSCR17，JAK1 and miR-30a-5p had a targeted regulatory rela- tionship． Conclusion Knockdown of circ_WBSCR17 can reduce high glucose-induced fibrosis and inflammation in human mesangial cells by regulating the miR-30a-5p /JAK1 axis.

Oxidative stress injury and mitochondrial dysfunction are major obstacles to neurological functional recovery after ischemic stroke. The development of new approaches to simultaneously diminish oxidative stress and resist mitochondrial dysfunction is urgently needed. Inspired by the overproduced reactive oxygen species (ROS) at ischemic neuron mitochondria, multifunctional nanoparticles with ROS-responsiveness and mitochondrial-targeted (SPNPs) were engineered, achieving specific targeting delivery and controllable drug release at ischemic penumbra. Due to the nose-to-brain pathway, SPNPs which were encapsulated in a thermo-sensitive gel by intranasal administration were directly delivered to the ischemic penumbra bypassing the blood‒brain barrier (BBB) and enhancing delivery efficiency. The potential of SPNPs for ischemic stroke treatment was systematically evaluated in vitro and in rat models of middle cerebral artery occlusion (MCAO). Results demonstrated the mitochondrial-targeted and protective effects of SPNPs on H₂O₂-induced oxidative damage in SH-SY5Y cells. In vivo distribution analyzed by fluorescence imaging proved the rapid and enhanced active targeting of SPNPs to the ischemic area in MCAO rats. SPNPs by intranasal administration exhibited superior therapeutic efficacy by alleviating oxidative stress, diminishing inflammation, repairing mitochondrial function, and decreasing apoptosis. This strategy provided a multifunctional delivery system for the effective treatment of ischemic injury, which also implies a potential application prospect for other central nervous diseases.