ObjectiveTo report the treatment of the first imported Middle East respiratory syndrome (MERS) in China, and to investigate the clinical features and treatment of the patient.Methods On May 28th, 2015, the first patient of imported MERS to China was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital. The clinical features and treatments of this patient were analyzed.Results①A 43 years old male of South Korean nationality was admitted with the complaint of back ache for 7 days and fever 2 days with the following characteristics: back ache 7 days ago, without fever or cough or expectoration. He had been suspected to suffer from infection of Middle East respiratory syndrome coronavirus (MERS-CoV) by the Disease Control Department of South Korea, but no specific treatment was given. He had fever for 2 days with maximum body temperature of 39.7℃. He had no chills, cough, expectoration, short of breath, abdominal pain, diarrhea, frequent micturition, or urgency or pain of urination, and no sore throat. The patient had a history of exposure to MERS-CoV patient. He was considered to be a patient of the second batch of South Korean epidemic.② Auxiliary examination: 3 copies of throat swab specimens for virus nucleic acid detection were performed by the Disease Prevention Control Center of China (China CDC), and they were positive on May 29th, 2015, and also for serum, sputum and stool. Based on the results of whole genome sequence analysis, the virus strains were implicated to be derived from Riyahh and Jeddah regions of Saudi Arabia. On admission, the patient's blood test showed that the white blood cell count was low (3.22×109/L), the proportion of the neutrophils was high (0.73), and that of the platelet was low (81×109/L). On admission, the patient's chest X-ray showed that a small amount of infiltration in the lung.③ Treatment: a high-flow nasal cannula (HFNC) with oxygen concentration of 0.50-0.80 was given, with a flow rate was set at 60 L/min if tolerated. It was changed to a low flow oxygen inhalation nasal cannula on the 20th day, and oxygen treatment was stopped on the 24th day. Ribavirin 2.0 g was given as the first dose, and was switched to 600 mg every 8 h (q8h), and it was reduced to 600 mg q12h after 10 days, and extenuated since the 13th day. Ceftriaxone was added on the 4th day with 2.0 g a day , and it was changed to meropenem 2.0 g, q8h on the 7th day for 2 weeks. Gamma globulin was given for 7 days (20 g, qd). Thymosin-α1 was given on the 8th day for 2 weeks. Interferon was given once a week, but only one dose was used. At the same time symptomatic treatment such as methimazole and liver protection therapy were given.④ Patient began to cough at admission, and it disappeared on the 18th day. There was no sputum at first, then a small amount of sputum with a little blood appeared after the admission. Then there was cough without sputum. Mild shortness of breath and diarrhea after exertion were noticed. He had no chest pain, difficulty in breathing or other symptoms. There was dullness on percussion in both sides of chest, and it disappeared gradually. Fine moist rales were detectable in scapular area and interscapular area on the 5th day, and they disappeared after 3 days. Breath sounds on both sides was weak, and it became more obvious in the right lung after 5 days, and returned to normal after 18 days. He had a sustaining fever for 1 week with the maximum temperature of 39.5℃, then the body temperature returned to normal. The viral nucleic acid test as performed by the Center for Disease Control of Guangdong (CDC, Guangdong) showed that the pharyngeal swab cultured turned negative on the 3rd day, that of serum specimens turned negative on the 8th day, that of stool specimen after 2 weeks, and it was persistently positive for sputum culture until 5 days before discharge. The oxygenation index gradually increased, and it was over 300 mmHg (1 mmHg = 0.133 kPa) after 15 days. Pleural effusion was rapidly increased during the first week as shown by chest X-ray films, and it began to be absorbed gradually in the second week, but it was not completely absorbed until discharge.Conclusions The disease course of the reported patient was short, with an acute onset, with fever as the chief complaint, but there were no respiratory symptoms, though there were high fever, cough, shortness of breath, diarrhea and other clinical symptoms after admission. Virus in sputum disappeared after treatment, but pleural effusion was not completely absorbed. Negative test for virus in sputum was late, indicating that clearance of virus was slow from the lungs. It is the first case of MERS in China, therefore, the clinical manifestations and the treatment strategy need to be further explored.

ObjectiveTo investigate the value of high flow nasal cannula (HFNC) in treating a patient with Middle East respiratory syndrome (MERS).Methods The effect of HFNC applied in the first imported MERS patient with complication of acute respiratory distress syndrome (ARDS) to China was observed. The patient was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital on May 28th, 2015, and the changes in various clinical parameters and their significance were analyzed.Results A 43-year old male was admitted to negative pressure isolation intensive care unit with the complaint of back ache for 7 days and fever for 2 days. Vital signs and saturation of pulse oximetry (SpO2) were monitored continuously. After admission, ribavirin was given orally for 12 days andα-interferon was administered once on the first day. However, after 2-week anti-virus therapy, the virus test was positive. Ceftriaxone was given on the 4th day, and it was changed to meropenem on the 3rd day for 2 weeks. Immune globulin was given on the 4th day and continued for 1 week. Thymosin-α1 was given on the 8th day and continued for 2 weeks. According to his past history, methimazole had been given continuously for hyperthyroidism and other symptomatic treatment. Oxygen inhalation (6 L/min) was given immediately after admission, but the condition of patient worsened with the following symptoms: frequent cough and obvious shortness of breath. Moreover pleural effusion gradually increased as shown by X-ray. SpO2 was maintained only at about 0.91. Oxygenation index (PaO2/FiO2) decreased to 144 mmHg (1 mmHg = 0.133 kPa). So oxygen inhalation via nasal cannula was changed to HFNC after 2 days. The parameters were set as follows: temperature 34℃, flow rate 20 L/min, fraction of inspired oxygen (FiO2) 0.50. The flow was raised 5 L/min every 10 minutes, and was continued till the target value reached 60 L/min. FiO2 was modified according to SpO2 and PaO2/FiO2. FiO2 was set to 0.80 on the 5th day of admission. Shortness of breath of the patient was improved on the 7th day of admission after the application of HFNC. FiO2 was then decreased to 0.58 as PaO2/FiO2 rose. Then the flow was gradually decreased to 30 L/min. HFNC was reduced with continuous improvement in PaO2/FiO2. HFNC was changed to low flow oxygen inhalation nasal cannula (2-3 L/min) on the 20th day. Oxygen treatment was stopped on the 23rd day, and SpO2 was maintained at 0.98-1.00. Activities on bed were gradually increased. The patient was cured and discharged from hospital on June 26th. The patient showed good tolerance and high compliance during the treatment with HFNC. No nosocomial spread occurred during the treatment.ConclusionsHFNC could improve respiratory function of the patient with MERS obviously, and complication ARDS was prevented. HFNC might reduce nosocomial spread.

Objective To investigate the clinical efficacy and safety of radiofrequency ablation (RFA)combined with low frequency ultrasound radiation with microbubble for the treatment of malignant liver neoplasms.Methods The clinical data of 25 patients with malignant liver neoplasms who received RFA combined with low frequency ultrasound radiation with microbubble at the Kunming General Hospital from January 2010 to June 2011 were retrospectively analyzed.RFA was firstly performed with ultrasonic guidance,and then low frequency ultrasound radiation with microbubble was performed according to the results of ultrasound contrast examination 1 week after RFA.Ultrasound contrast examination was performed and the hepatic function and serum alpha fetoprotein (AFP) were assayed before operation,3 and 6 months after operation,respectively.All data were analyzed using the t test or chi-square test.Results The gross tumor volumes of 16 patients reduced by 30％ at 3 months after operation when compared with that before operation.The gross tumor volumes of 17 patients reduced by 50％ at 6 months after operation when compared with that before operation.The gross tumor volume of 7 patients reduced,but tissues surrounding tumors showed the signal of bloodstream.The gross tumor volume of 1 patient did not reduce.The levels of aspartate aminotransferase (AST),total bilirubin (TBil) and alpha fetoprotein (AFP) at 3 months after operation were significantly lower than those before operation (t =23.51,13.79,257.07,P ＜0.05).The levels of alanine aminotransferase (ALT),AST,TBil and AFP at 6 months after operation were significantly lower than those before operation (t =5.67,27.19,21.02,333.46,P ＜ 0.05).No local recurrence was detected during a follow-up of 6 months.The scores of quality of life (QOL) were very good in 21 (84.0％) patients,good in 2 (8.0％) patients,fair in 1 (4.0％) patient and poor in 1 (4.0％) patient.The scores of Karnofsky (KPS)were improved in 19 (76.0％) patients,stable in 5 (20.0％) patients and aggravated in 1 (4.0％) patient.There were significant differences in QOL and KPS between pre-and postoperation (x2=41.600,18.960,P ＜0.05).Conclusion RFA combined with low frequency ultrasound radiation with microbubble is effective in reducing the tumor size and protect the hepatic function for patients with malignant liver neoplasms.

Aim at the two problems in the field of traditional Chinese medicine (TCM) mechanism elucidation, one is the lack of detailed biological processes information, next is the low efficient in constructing network models, we constructed an auxiliary elucidation system for the TCM mechanism and realize the automatic establishment of biological network model. This study used the Entity Grammar Systems (EGS) as the theoretical framework, integrated the data of formulae, herbs, chemical components, targets of component, biological reactions, signaling pathways and disease related proteins, established the formal models, wrote the reasoning engine, constructed the auxiliary elucidation system for the TCM mechanism elucidation. The platform provides an automatic modeling method for biological network model of TCM mechanism. It would be benefit to perform the in-depth research on TCM theory of natures and combination and provides the scientific references for R&D of TCM.
Animals ; Automation ; instrumentation ; methods ; Databases, Factual ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Gene Regulatory Networks ; Humans ; Medicine, Chinese Traditional ; Plants, Medicinal ; chemistry

Objective To investigate the relationship between metabolic syndrome (MS) and education level in Su-Xi-Chang area to provide evidence for healthcare policy making. Methods A clustered sampling of 6798 subjects from Su-Xi-Chang areas of Jiangsu Province was included. Questionnaires and physical examinations were completed to collect clinical data. Logistic regression was used to analyze weather education level could be an independent risk factor of MS. Results Significant differences were found in waist circumstance (WC) ,systolic blood pressure (SBP) and fasting blood glucose (FBG) among participants with different education level. Significant differences were also existed in triglyceride and diastolic blood pressure (DBP) between subjects with higher and lower education level ( P＜0. 05 ). In single-factor or multivariate analysis, education level was negatively correlated with the prevalence of MS (P＜0. 05 ). Conclusions Education level may be an independent risk factor of MS. People with low and moderate education level have higher risk of MS. Therefore,it is recommended that health-related information should become an integral part of the compulsory education system.

OBJECTIVETo evaluate the accuracy of the latest BladderScan BVI9400 on measuring bladder volume.

METHODSTwo bladder phantoms were selected for investigating the accuracy of BVI9400. 341 patients with the iU22 ultrasound examinations were followed by BVI 9400. The difference and correlation between BVI9400 and iU22 were contrastively analyzed.

RESULTSThe relative difference between results from BVI9400 and phantom volume was 2.5% and 1.36%. There was a strong correlation for patients between BVI9400 and iU22 (R = 0.96, P < 0.001). The relative difference between BVI9400 and iU22 decreased with the increasing of bladder volume and had no significant difference with patient's gender (P > 0.1).

CONCLUSIONBladderScan BVI9400 had the ability of high accuracy and good stability of measured data. In view of quick and conveniences, BVI9400 could be as auxiliary equipment on pelvic tumor to evaluate whether the bladder volume during fractional radiotherapy was consistency with that during CT positioning.

AIM To compare the contents of benzoyl mesaconitine,benzoyl hypaconitine,benzoyl aconitine,aconitine,hypaconitine and mesaconitine in Zingiberis Rhizoma Recens boiled juice-processed,Zingiberis Rhizoma boiled juice-processed,Zingiberis Rhizoma Recens juicing-processed,Zingiberis Rhizoma Recens slice malaxation steaming,and Zingiberis Rhizoma slice malaxation steaming Aconiti lateralis Radix Praeparata.METHODS Acid-base titration method was adopted in the content determination of total alkaloids.HPLC was applied to determining the contents of six alkaloids,the analysis was performed on a 35 ℃ thermostatic Waters Symmetry(C)C1scolumn (4.6 mm × 250 mm,5 μm),with the mobile phase comprising of acetonitrile-0.04 mol/L ammonium acetate flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 235 nm.RESULTS The contents of total alkaloids and diester-type alkaloids (mesaconitine,aconitine and hypaconitine)in various processed products,especially for Zingiberis Rhizoma Recens slice,Zingiberis Rhizoma slice malaxation steaming products,were obviously lower than those in the raw product.The contents of benzoyl hypaconitine and benzoyl aconitine in Zingiberis Rhizoma slice malaxation steaming product were the lowest,while that of benzoyl mesaconitine in the raw product was the lowest.CONCLUSION Compared with other Zingiber-processing methods,both Zingiberis Rhizoma Recens slice and Zingiberis Rhizoma slice malaxation steaming can reduce the toxicity of Aconiti lateralis Radix Praeparata more effectively.

Objective To observe the clinical efficacy of electroencephalogram (EEG)-guided scalp acupuncture plus body acupuncture in treating epilepsy.Method Sixty epilepsy patients in interictal stage were randomized into a guided acupuncture group, a body acupuncture group, and a Western medication group. The guided acupuncture group was given scalp plus body acupuncture under the guidance of EEG; the body acupuncture group was given ordinary body acupuncture treatment; the Western medication group didn't receive acupuncture treatment. The clinical efficacy was evaluated; before and after the treatment, the powers ofα,β,θ andδ bands and interictal epileptic activity (IEA) were observed by EEG and brain electrical activity mapping (BEAM).Result After the treatment, IEA declined significantly in all cases according to EEG (P<0.05), while the guided acupuncture group was insignificantly different from the other two groups in comparing IEA (P>0.05). In the guided acupuncture group and body acupuncture group, the absolute powers ofα1,α2 andβ2 bands were significantly improved, and the powers ofθ andδ bands were decreased significantly (P<0.05); the values of these two groups were significantly different from those of the Western medication group (P<0.05), but the guided acupuncture group showed a more significant effect in improving EEG power spectrum compared to the body acupuncture group (P<0.05).Conclusion EEG-guided scalp plus body acupuncture is effective in treating epilepsy, which is possibly related to the inhibition of IEA and improvement of EEG power spectrum.

OBJECTIVETo observe the effects of oxymatrine on the expression of interleukin-6 (IL-6), interleukin-1beta (IL-1beta) mRNA of human periodontal ligament cell (PDLC) stimulated by lipopolysaccharides (LPS), and to discuss oxymatrine's inhibition mechanism on periodontal inflammation stimulated by LPS.

METHODSFirstly, isolate PDLC externally and culture them; for oxymatrine experimental group we used different combination of LPS and oxymatrine in different concentration, and for the matched group we use DEME nutrient solutions of 1% FBS. Then reverse transcription-polymerase chain reaction (RT-PCR) for checking the level of IL-6 and IL-1beta mRNA.

RESULTS25 microg x mL(-1) LPS can significantly enhance the expression of both IL-6 and IL-1beta mRNA's level, and oxymatrine could restrain above phenomena.

CONCLUSIONOxymatrine can restrain the expression of IL-6 and IL-1beta mRNA of human PDLC stimulated by LPS.

OBJECTIVE To have a systematic pathomechanism view of three chest impediment-syndromes of Qi Deficiency and Blood Stasis syndrome(QDBS),Qi Stagnation and Blood Stasis syn-drome (QSBS), Cold Obstruction and Qi Stagnation syndrome(COQS) and further investigate the changed metabolome and related pathways for screening potential biomarkers in rat plasma. METHODS According to clinical pathogeny, three kinds of syndrome models were established to simulate the disease of chest impediment. Plasma metabonomics based on UPLC-Q-TOF/MS was applied in this research to detected small molecule metabolites for identifyingthe special potential biomarkers of three chest impediment syndromes, respectively. RESULTS Significant metabolic differences were observed between thecontrol group and three syndrome groups. Furthermore, three syndrome groups were distinguished clearly by pattern recognition method.The particular metabolites contributing most to the classification of three chest impediment syndromes were identified. In the QSBS group, the potential biomarkers could include 2-keto-glutaramic acid, L-methionine, L-homocysteic acid, octadecanamide, stearoylglycine,behenic acid,linoleylcarnitine,lysoPC(14:1(9Z)),indoxyl sulfate and cholic acid.In the COQS group, they could be aminoadipic acid, palmitic amide, oleamide, lysoPC(P-16:0), lysoPC(P-18:0), lysoPC(20:2(11Z,14Z)), 9-HETE and tauroursodeoxycholic acid. Moreover, 4-pyridoxic acid, L-palmi-toylcarnitine, lysoPC(20:0), lysoPC (22:5 (4Z,7Z,10Z,13Z,16Z)), 3- hydroxyhexadecanoic acid and arachidonic acid could be the potential biomarkers for the QDBS group. CONCLUSION Three chest impediment syndromes have their own potential biomarkers.Each special metabolite has its owndifferent metabolic pathway.Both metabolismof cysteine and methionine,and metabolism of alanine,aspartate and glutamate are the main pathways in regulation of metabolic disorders in QSBS syndrome. Lysine biosynthesis and degradation,fatty acid metabolism,and glycerophospholipid metabolism are the main pathways in regulation of metabolic disorders in COQS syndrome.Arachidonic acid metabolism, fatty acid metabolism,fatty acid elongation in mitochondria,and vitamin B6 metabolism are the main pathways in regulation of metabolic disorders in QDBS syndrome.These endogenous substances were indicated as the special potential biomarkers for three chest impediment syndromes and worth studying in depth.