This article expounds the formation,connotation and development of the etiology theory in TCM.By analyzing the deficiency of the existent etiology theory in TCM,we proposed that the essence of the etiology theory in TCM should be studied based on the concept of unification of human and nature.With the guidance of the concept of unification of human and nature,the etiology theory in TCM could be formed an integrated theory.The classification of etiology in TCM which includes basic etiology,secondum etiology and developing etiology was proposed,which makes the etiology theory system in TCM more scientific and logical.

Objective:To study the effects of different Epstein-Barr virus (EBV) DNA load, induction chemotherapy+ radiotherapy and concurrent radiochemotherapy on patients with stage Ⅲ nasopharyngeal carcinoma (NPC).Methods:A total of 178 patients with stage Ⅲ NPC were selected as the study subjects in the Department of Otorhinolaryngology of the First People′s Hospital of Xianning of Hubei Province from January 2012 to March 2019, including 44 patients received adjuvant chemotherapy. According to the pre-treatment EBV DNA load of 1 000 copies/ml, the patients were divided into high viral load group (EBV DNA≥1 000 copies/ml, n=53) and low viral load group (EBV DNA<1 000 copies/ml, n=125), and 14 patients in the high viral load group and 30 patients in the low viral load group received adjuvant chemotherapy. According to treatment method, the patients were divided into induction chemotherapy+ radiotherapy group ( n=105) and concurrent radiochemotherapy group ( n=73). The general clinical data, recurrence rate, 5-year overall survival (OS) rate, disease free survival (DFS) rate, local recurrence free survival (LRFS) rate and disease metastasis-free survival (DMFS) rate of each group were compared. Results:Among 178 patients with stage Ⅲ NPC, 34 cases recurred, accounting for 19.10%, and 29 cases died, accounting for 16.29%. There was a statistically significant difference in N staging between the induction chemotherapy+ radiotherapy group and the concurrent radiochemotherapy group ( χ2=6.40, P=0.01). The tumor recurrence rate in the high viral load group was 33.96% (18/53), and that in the low viral load group was 12.80% (16/125), and there was a statistically significant difference ( χ2=10.79, P<0.01). The recurrence rate of lymph nodes [(9.43% (5/53) vs. 1.60% (2/125), χ2=4.15, P=0.04], the distant metastasis rate [18.87% (10/53) vs. 5.60% (7/125), χ2=7.59, P=0.01] were significantly higher than those in the low viral load group, and there were statistically significant differences. The tumor recurrence rate of patients in the induction chemotherapy+ radiotherapy group was 17.14% (18/105), and that in the concurrent radiochemotherapy group was 21.91% (16/73), and there was no statistically significant difference ( χ2=0.63, P=0.43). The 5-year OS rate, DFS rate, LRFS rate and DMFS rate of 178 patients with stage Ⅲ NPC were 84.68%, 72.80%, 79.68% and 79.54%, respectively. The 5-year OS rate (79.25% vs. 92.80%, χ2=6.86, P<0.01), DFS rate (73.58% vs. 88.00%, χ2=5.67, P=0.01), LRFS rate (73.21% vs. 89.24%, χ2=8.32, P<0.01) and DMFS rate (65.24% vs. 78.00%, χ2=4.15, P=0.02) in the high viral load group were significantly lower than those in the low viral load group, and there were statistically significant differences. The 5-year OS rate (89.52% vs. 87.67%, χ2=0.15, P=0.70), DFS rate (84.76% vs. 82.19%, χ2=0.21, P=0.65), LRFS rate (80.38% vs. 79.84%, χ2=0.00, P=1.00) and DMFS rate (79.52% vs. 81.78%, χ2=0.05, P=0.83) in the induction chemotherapy+ radiotherapy group were not statistically significant compared with those in the concurrent radiochemotherapy group, and there were no statistically significant differences. The 5-year OS rate of 44 patients receiving adjuvant chemotherapy was significantly higher than that of patients who did not receive adjuvant chemotherapy (93.77% vs. 87.49%), and there was a statistically significant difference ( χ2=5.21, P=0.02). In the high viral load group, the 5-year OS rate of patients receiving adjuvant chemotherapy was significantly higher than that of patients who did not receive adjuvant chemotherapy (93.77% vs. 84.13%), and there was a statistically significant difference ( χ2=5.11, P=0.03). Conclusion:Induction chemotherapy+ radiotherapy can achieve the same therapeutic effect as concurrent radiochemotherapy. High viral load is associated with high recurrence rate and poor survival rate. For these patients with high viral load, treatment intensity needs to be strengthened.

Objective The aim of this study was to compare hypophosphatemia between the sepsis patients and the non-sepsis patients,and between within the subgroups of sepsis patients.Methods We collected 312 sepsis cases and 300 non-sepsis cases by stratified random sampling method yearly.In the sepsis cases,the number infected by gram-negative bacteria was 170,and by gram-positive bacteria was 142,containing 4 different bacteria infected cases in each one.Serum phosphorus of cases in each group were collected.The data were statistically processed to compare the incidence rates of hypophosphatemia,mean serum phosphorus levels and relative risk among groups.Results There was a statistical difference between the sepsis cases and the non-sepsis cases in incidence rate of hypophosphatemia (P ＜ 0.05,and RR ＞ 1.2).There were statistical differences between the cases infected by gram-negative bacteria and the cases infected by the gram-positive bacteria,also among cases infected by 4 different gram-positive bacteria in both incidence rate of hypophosphatemia and average serum phosphorus level (all P ＜ 0.05),and both RR ＞ 1.2.There were no statistical differences among cases infected by 4 different gram-negative bacteria in both incidence rate of hypophosphatemia and average serum phosphorus level (both P ＞ 0.05),and RR ＜ 1.2.Conclusions The sepsis patients were susceptible to hypophosphatemia,especially the ones infected by the 4 gram-negative bacteria,staphylococcus aureus and enterococcus in this study.We should pay attention to the serum phosphorus level seriously and prevent the occurrence of serious complications.

Purpose To find the reasons and explore the appropriate countermeasures for failure ureteroscopy operation.Methods The clinical data of 74 cases with failure ureteroscopy operation for ureteral calculi were analysed respectively.Results The failure reasons including the difficult of ureteroscopy insert (46 lateral),difficult of calculi disposal (12 lateral) and ureteral injure (15 lateral).ESWL(34 sides) and open surgery(44 sides) were remedial measures after failure ureteroscopy and the success rates were 85 3%, 100% respectively.nephrectomy were carried out in and 1 case died from serious uriaemia.The mortality was only 1.4%.Conclusions The reasons of failure including unable approach the stone, difficult to disposal calculi and ureteral injury. The effect is related to applicances, experience, indications . ESWL and open surgery are the suitable remedy measures according to the failure reason.

Objective:To investigate the clinical efficacy and safety of compound carraghenates suppositories in the treatment of wounds after anal fissure operation. Methods:Eighty-eight cases of patients with anal fistula post-operation wounds were diagnosed from June 2011 to June 2014 and randomly divided into the observation group (n=44) and the control group (n=44). The control group was treated with the conventional treatment and the observation group was treated with external compound carraghenates suppositories additionally. The efficacy, average healing time, growing time of granulation tissue and removal time of necrotic tissue, pain disappear-ance time and wound edema disappearance time after the operation and the area of wound surface in the two groups were observed and compared. Results:After the 14-day treatment, the time of wound healing, granulation growth and cure in the observation group was shorter than that in the control group (P<0. 05). In the observation group, the total effective rate (93. 18%) was higher than that in the control group (77. 27%, P<0. 05). After the 7-day and 14-day treatment, the pain score and wound edema score in the observa-tion group were significantly lower than those in the control group (P<0. 05), and the wound area was significantly smaller than that in the control group (P<0. 05). Conclusion:The clinical efficacy of external compound carraghenates suppositories in the treatment of wounds after anal fissure operation is significant, safe and reliable.

Objective To explore the mechanism of arginine vasopressin(AVP) in the onset of febrile convulsion.Methods Radioimmunoassay(RIA) was used to determine plasma AVP levels in 24 children with complicated febrile convulsion,32 children with simple febrile convulsion,20 children with upper respiratory infection,and 18 normal children.Their plasma sodium ion and plasma osmotic pressure were measured at the same time.Results AVP level in complicated febrile convulsion group and simple febrile convulsion group was significantly higher than upper respiratory infection group and control group(P

Objective To study the related factors of no or weak immune response after inoculation of hepatitis B vaccine .Meth‐ods 120casesofadultreceivedinoculationofhepatitisBvaccineinourhospitalwereenrolled,including60casesofnoweakre‐sponse and 60 cases of normal response ,they were divided into non response group and response group .Related factors of no or weakimmuneresponsewereanalyzed.Results (1)singlefactoranalysis:Therewerestatisticalsignificanceofage,gender,BMI, smoking history ,HBV potential infection ,CD4+ T cells and CD8+ T cell content ,IFN‐γand IL‐2 content between two groups ;(2) logistic regression analysis :old age ,male ,smoking history ,high values of BMI ,HPV latent infection ,low content of CD4+ T cells and IFN‐γand IL‐2 ,high content of CD8+ cells were risk factors of no or weak immune response after inoculation of hepatitis B vaccine .Conclusion No or weak immune response after inoculation of hepatitis B vaccine is affected by gender ,age ,smoking ,obesi‐ty ,potential infection of HPV and immune function ,and necessary measure should be taken .

Objective To investigate the effect of dexmedetomidine on emergence agitation (EA) following sevoflurane anesthesia in children with cerebral palsy.Methods Fifty ASA physical status Ⅰ or Ⅱ children with cerebral palsy of both sexes,aged 2-12 yr,scheduled for elective muscle strength muscle tension adjustment method,were randomly allocated into 2 groups (n =25 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv injection of sufentanil 0.3 μg/kg,cisatracurium 0.15 mg/kg,and propofol 1.5 mg/kg.The patients were tracheal intubated and mechanically ventilated.Dexmedetomidine 0.5 μg/kg was intravenously infused over 15 min after induction of anesthesia in group D and the equal volume of normal saline was given in group C.The operation was begun at the end of administration.Anesthesia was maintained with inhalation of 2％-4％ sevoflurane and the concentration was adjusted to achieve a target BIS value of 45-60.The heart rate,systolic blood pressure and diastolic blood pressure were recorded before infusion of dexmedetomidine (T1) and at skin incision (T2).The extubation time,emergence time and consumption of sevoflurane were also recorded.The end-tidal sevoflurane concentration was recorded at T1,T2,and the end of operation (T3).The adverse cardiovascular events and occurrence of EA were also recorded.The degree of EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale.The peripheral venous blood samples were collected at T1,T2,T3 and extubation (T4) for determination of the blood glucose level and serum cortisol concentration.Compared with group C,the emergence time and extubation time were significantly shortened,and the consumption of sevoflurane,end-tidal sevoflurane concentrations at T2 and T3,PAED scores,incidence of agitation,and the blood glucose level and serum cortisol concentration at T4 were significantly decreased in group D (P ＜0.05 or 0.01).There was no significant difference in the incidence of bradycardia or heart rate,systolic blood pressure and diastolic blood pressure at each time point between the two groups (P ＞ 0.05).Conclusion Dexmedetomidine can decrease the development and degree of EA following sevoflurane anesthesia in children with cerebral palsy.

Objective To investigate the clinical features and treatment of Kaposi's varicelliform eruption. Methods Clinical data on 24 cases of Kaposi's varicelliform eruption were retrospectively analyzed.Results All the 24 patients were accompanied by different underlying skin diseases, including eczema in 17 cases and atopic dermatitis in 7 cases. PCR of vesicle fluid was positive for herpes simplex virus type 1 (HSV 1 ) in 16 (66.67%) patients, and culture of vesicle fluid or lesional exudates grew Staphylococcus aureus in 12 (50%) patients. Conclusion Infants with atopic dermatitis or eczema are rather susceptible to Kaposi's varicelliform eruption, which may be partly caused by herpes simplex virus infection.

Objective To examine the incidence and risk factors associated with atrial fibrillation in elderly coronary heart disease patients who underwent off-pump coronary artery bypass surgery.Methods From Jun.2008 to Jun.2009,one hundred and eleven patients received OPCAB in our hospital.Clinical data including coronary angiography,diseased vessels,number of bypass grafts,postoperative electrolyte,postoperative hemodynamic measurements,anti-arrhythmic drugs used and other risk factors for atrial fibrillation was collected and reviewed individually.The mean age of patients was(73.19±2.79)years(range from 70 to 82 years).Seventy-nine patients were male and 32 were female.The mean left ventricular ejection fraction(LVEF)was 0.57±0.12,NYHA Ⅰ-Ⅳ.All patients received OPCAB.Saphenous vein(SV)and left internal mammary artery(LIMA)were harvested and used as grafts.LIMA was routinely anastomosed to the left anterior descending artery (LAD),and SV was anastomosed to the other target vessels.The average number of grafts.was(2.79±0.54)per case.The mean operation time was(3.70±0.88)hours and the duration of ICU-staying was(1.32±0.94)days.The patients were divided into 2 groups:atrial fibrillation group and non-atrial fibrillation group.Results Four deaths occurred perioperatively.The mortality was 3.42%.Major postoperative complications included low cardiac output,respiratory dysfunction and acute kidney injury.Twenty seven out of 111 patients who underwent off-pump coronary artery bypass surgery had atrial fibrillation postoperatively.The incidence was 24.3%.Single factor analysis revealed that CVP,serum levels of potassium,magnesium,and SPO2 were lower significantly in atrial fibrillation group than those in the non-atrial fibrillation group,P<0.05.Conclusion Changes of perioperative electrolytes and circulating blood volume,decline in the oxygen saturation,and the occurrence of perioperative myocardial infarction after coronary artery bypass surgery were the risk factors associated with atrial fibrillation.