OBJECTIVETo explore the comprehensive methods of acupoint indications in The Yellow Emperor's Mingtang Classic.

METHODSBased on The Yellow Emperor's Mingtang Classic recovered and edited by Prof. HUANG Long-xiang, the characteristics of acupoint indications in The Yellow Emperor's Mingtang Classic was analyzed. On this basis and in combination with typical examples, it was mainly analyzed how to correctly understand the original intention and meaning of acupoint indications in The Yellow Emperor's Mingtang Classic.

CONCLUSIONTo understand acupoint indications in The Yellow Emperor's Mingtang Classic, it should be taken apart layer upon layer successively, and then identify four contents: acupuncture prescriptions and acupoint indications, different components of acupoint indications, syndrome groups, names of diseases and symptoms.

Acupuncture Points ; Acupuncture Therapy ; history ; Diagnosis, Differential ; History, Ancient ; Humans ; Medicine, Chinese Traditional ; history

BACKGROUND: Increased extravascular lung water (EVLW) in shock is common in the critically ill patients. This study aimed to explore the effect of cardiac output (CO) on EVLW and its relevant influence on prognosis. METHODS: The hemodynamic data of 428 patients with pulse-indicated continuous CO catheterization from Department of Critical Care Medicine, Peking Union Medical College Hospital were retrospectively collected and analyzed. The patients were assigned to acute respiratory distress syndrome group, cardiogenic shock group, septic shock group, and combined shock (cardiogenic and septic) group according to their symptoms. Information on 28-day mortality and renal function was also collected. RESULTS: The CO and EVLW index (EVLWI) in the cardiogenic and combined shock groups were lower than those in the other groups (acute respiratory distress syndrome group vs. cardiogenic shock group vs. septic shock group vs. combined shock group: CO, 5.1 [4.0, 6.2] vs. 4.7 [4.0, 5.7] vs. 5.5 [4.3, 6.7] vs. 4.6 [3.5, 5.7] at 0 to 24 h, P = 0.009; 4.6 [3.8, 5.6] vs. 4.8 [4.1, 5.7] vs. 5.3 [4.4, 6.5] vs. 4.5 [3.8, 5.3] at 24 to 48 h, P = 0.048; 4.5 [4.1, 5.4] vs. 4.8 [3.8, 5.5] vs. 5.3 [4.0, 6.4] vs. 4.0 [3.2, 5.4] at 48 to 72 h, P = 0.006; EVLWI, 11.4 [8.7, 19.1] vs. 7.9 [6.6, 10.0] vs. 8.8 [7.4, 11.0] vs. 8.2 [6.7, 11.3] at 0 to 24 h, P < 0.001; 11.8 [7.7, 17.2] vs. 7.8 [6.3, 10.2] vs. 8.7 [6.6, 12.2] vs. 8.0 [6.6, 11.1] at 24 to 48 h, P < 0.001; and 11.3 [7.7, 18.7] vs. 7.5 [6.3, 10.0] vs. 8.8 [6.3, 12.2] vs. 8.4 [6.4, 11.2] at 48 to 72 h, P < 0.001. The trend of the EVLWI in the septic shock group was higher than that in the cardiogenic shock group (P < 0.05). Moreover, there existed some difference in the pulmonary vascular permeability index among the cardiogenic shock group, the septic shock group, and the combined shock group, without statistical significance (P > 0.05). In addition, there was no significant difference in tissue perfusion or renal function among the four groups during the observation period (P > 0.05). However, the cardiogenic shock group had a higher 28-day survival rate than the other three groups [log rank (Mantel-Cox) = 31.169, P < 0.001]. CONCLUSION Tissue-aimed lower CO could reduce the EVLWI and achieve a better prognosis.

OBJECTIVE: Sepsis is a deadly infection that causes injury to tissues and organs. Infection and anti-infective treatment are the eternal themes of sepsis. The successful control of infection is a key factor of resuscitation for sepsis and septic shock. This review examines evidence for the treatment of sepsis. This evidence is combined with clinical experiments to reveal the rules and a standard flowchart of anti-infection therapy for sepsis. DATA SOURCES: We retrieved information from the PubMed database up to October 2018 using various search terms and their combinations, including sepsis, septic shock, infection, antibiotics, and anti-infection. STUDY SELECTION: We included data from peer-reviewed journals printed in English on the relationships between infections and antibiotics. RESULTS: By combining the literature review and clinical experience, we propose a 6Rs rule for sepsis and septic shock management: right patients, right time, right target, right antibiotics, right dose, and right source control. This rule encompasses rational decisions regarding the timing of treatment, the identification of the correct pathogen, the selection of appropriate antibiotics, the formulation of a scientifically based antibiotic dosage regimen, and the adequate control of infectious foci. CONCLUSIONS This review highlights how to recognize and treat sepsis and septic shock and provides rules and a standard flowchart for anti-infection therapy for sepsis and septic shock for use in the clinical setting.
Anti-Bacterial Agents ; therapeutic use ; Anti-Infective Agents ; therapeutic use ; Humans ; PubMed ; Sepsis ; drug therapy ; Shock, Septic ; drug therapy

Objective To compare the effects of Eastern Association for Surgery of Trauma/American College of Critical Care Medicine/Society of Critical Care Medicine ( EAST/ACCM/SCCM) red blood cell trans-fusion in adult trauma and critical care guidelines (2009) guided red blood cell (RBC) transfusion strategy and tissue perfusion oriented RBC transfusion strategy in critically ill patients. Methods In 2013, RBC transfusion in Department of Critical Care Medicine of Peking Union Medical College Hospital followed the EAST/ACCM/SC-CM guidelines recommendation in critically ill patients, and in 2014 tissue perfusion oriented RBC transfusion strategy was adopted. The in-hospital mortality, length of Intensive Care Unit ( ICU) stay, incidence of new or-gan injury, mean pre-transfusion hemoglobin ( Hb) level, blood lactate acid level upon admission ( Lac admit-ted), pre-transfusion blood lactate acid level (Lac pre-transfusion), mean RBC transfusion volume, and inci-dence of transfusion-related complications in all ICU patients and patients with Acute Physiology and Chronic Health Evaluation Ⅱ ( APACHE Ⅱ) ≥15 were compared between the year 2013 and the year 2014 . Results In 2013 and 2014, 2110 and 2638 patients were admitted to ICU, respectively. The mean APACHEⅡscore up-on admission and the proportion of patients with APACHEⅡ≥15 were both higher in 2014 than in 2013 ( P<0. 05 ) . The proportion of patients treated with RBC transfusion was significantly lower in 2014 than in 2013 (P<0. 05). The mean pre-transfusion Hb level, Lac admitted, and the proportion of patients with Lac admitted<4 mmol/L showed no significant difference between the two years (P>0. 05). Lac pre-transfusion in 2014 was significantlyhigherthanthatin2013[(4.16±1.18) mmol/Lvs. (2.78±1.03) mmol/L,P=0.031]. Inthe patients treated with RBC transfusion, the proportion of patients with Lac admitted<4 mmol/L was significantly lower in 2014 than in 2013 (20. 5% vs. 33. 4%, P=0. 018). The mean RBC transfusion volume was significant lower in 2014 than in 2013 [(1. 02 ± 0. 51) U vs. (1. 55 ± 0. 70) U, P=0. 037]. The in-hospital mortality was not significantly different between the two years in all ICU patients (2. 77% vs. 2. 39%, P=0. 749), but the mean length of ICU stay was significantly shorter in 2014 than in 2013 [(5. 31 ± 1. 98) d vs. (6. 84 ± 2. 36) d, P=0. 025] . The incidences of new onset acute kidney injury, acute liver injury, acute myocardial injury, and acute lung injury showed no significant difference between the two years ( P>0. 05 ) . In patients with APACHEⅡ≥15, the in-hospital mortality was significant lower (7. 00% vs. 12. 01%, P=0. 018) and the length of ICU stay significantly shorter in 2014 than in 2013 [(7. 16 ± 3. 53) d vs. (12. 44 ± 5. 27) d, P<0. 001];the inci-dences of new onset acute kidney injury, acute myocardial injury, and acute lung injury were significantly lower in 2014 (P<0. 05). No transfusion-related infection or hemolysis occurred in the two years. The incidences of non-hemolytic febrile transfusion reaction and transfusion-related lung injury in all the ICU patients and patients with APACHE Ⅱ ≥15 were not significantly different between the two years ( P>0. 05 ) . Conclusions Com-pared with EAST/ACCM/SCCM guideline based RBC transfusion strategy, tissue perfusion oriented RBC transfu-sion strategy in critically ill patients can reduce RBC transfusion volume and shorten length of ICU stay. Especial-ly for ICU patient with APACHE Ⅱ ≥15 , it can also reduce in-hospital mortality and incidences of new onset acute kidney injury, acute myocardial injury, and acute lung injury, without increasing the incidence of transfu-sion-related complications.

Objective To investigate the risk factors related to outcome of patients with severe massive hemorrhage in Intensive Care Unit( ICU ). Methods Clinical data of all patients receiving transfusion of red blood cell( RBC)of ﹥20 U for severe massive hemorrhage,who were hospitalized between January 2013 and December 2015 in ICU of Peking Union Medical College Hospital,were analyzed retrospectively. Comparisons were conducted between patients who died( death group)and those survived( survival group). Risk factors relat-ed to outcome were analyzed with Logistic regression. Results A total of 141 patients were identified,of whom 78 survived. In-hospital mortality was 44. 7%(63/141). Among these patients with severe massive hemorrhage, there were 78 non-operation-related cases and 63 operation-related cases. The amount of RBC transfused in ICU ( P=0. 002 ),the proportion of non-operation-related cases( P=0. 002 ),and the proportion of patients from emergency department(P=0. 010)were all significantly higher in the death group than in the survival group, while the proportion of patients from surgical departments was lower in the death group than in the survival group (P=0. 001). The baseline coagulation,renal,and liver function before RBC transfusion were significantly worse in the death group than in the survival group( all P﹤0. 05 ). Among the patients with non-operation-related se-vere massive hemorrhage,the death group had significantly higher proportion of severe massive hemorrhage due to infections( P=0. 009 ),but significantly lower proportion of severe massive hemorrhage due to stress ulcer( P=0. 048 ),baseline platelet level( P =0. 003 ),and proportion of patients receiving surgical hemostasis( P =0. 039). Among the patients with operation-related severe massive hemorrhage,the death group had higher vol-ume of RBC transfusion in ICU( P=0. 019 ),but higher proportions of patients with liver or renal function im-pairment before RBC transfusion( both P﹤0. 05 ). Logistic regression analysis showed that coagulation disorders (P=0. 014,OR=3. 594)and the presence of active massive hemorrhage after admission into ICU(P=0. 025, OR=2. 680)were risk factors for death in the patients with severe massive hemorrhage. Conclusion For all the patients with severe massive hemorrhage,coagulation disorders and the presence of active massive hemorrhage in ICU may be risk factors for death.

OBJECTIVETo study the value and the clinical application of the Medical Image three-dimensional Visualization System of Abdomen (MI-3DVS) in diagnosis and evaluating resectability of pancreatic tumor.

METHODSTwelve patients with pancreatic tumor were tested with 64-slice helical CT (64-MSCT) angiography, and the CT data was reconstructed with MI-3DVS from November 2008 to August 2009. The 3D findings were adopted in diagnosis and evaluating resectability, and the results were compared with surgical operation and the pathological finding. There were 7 male and 5 female, aged from 14 to 83 years. Within the 12 cases, there were 4 cases with pancreatic carcinoma, 5 cases with pancreatic solid pseudopapillary tumor, 2 cases with pancreatic serous cystadenoma, 1 case with pancreatic cyst (ductal epithelial papillary hyperplasia).

RESULTSNine tumors which had been regarded as removable pre-operatively with MI-3DVS were removed successfully. Three patients who were considered unresectable by other hospitals with CT were operated successfully with MI-3DVS. The other 3 patients' tumors were actually not able to be removed as pre-operative evaluation.

CONCLUSIONMI-3DVS plays an important role in diagnosis and assessment of resectability of pancreatic tumor.

Adolescent ; Adult ; Aged ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Radiography, Abdominal ; methods ; Tomography, Spiral Computed ; Young Adult

OBJECTIVETo investigate the biochemical characteristic of the neurons associated Zusanli (ST 36) in the rat by using Alexa Fluor 594 conjugated cholera toxin subunit B (AF594-CTB) neural tracing and calcitonin gene-related peptide (CGRP) fluorescent immunohistochemical techniques.

METHODSFour male Sprague Dawley rats were injected with AF594-CTB into the corresponding area of the Zusanli in the human body. After 3 surviving days, the rat's spinal cord and dorsal root ganglia (DRGs) at lumbar segments were dissected following perfusion with 4% paraformaldehyde, cut into sections, and then stained with CGRPfluorescent immunohistochemical method.

RESULTSAF594-CTB labeled sensory neurons were detected in the L3-L6 DRGs with high concentration in L4 DRG, and the labeled motor neurons located in the dorsolateral and intermediate regions of lamina IX from L3-L5 segments with high concentration at L4. Meanwhile, CGRPpositive neural labeling distributed symmetrically on both sides of DRGs, anterior and dorsal horns of spinal cord. In the AF594-CTB labeled neurons, 37% sensory neurons and 100% motor neurons expressed CGRPpositive.

CONCLUSIONThese findings present the morphological evidence to demonstrate that the sensory and motor neurons associated Zusanli in the rat distributed with segmental and regional patterns, and contained CGRP-expression.

Acupuncture Points ; Animals ; Calcitonin Gene-Related Peptide ; metabolism ; Male ; Neurons ; metabolism ; Rats ; Rats, Sprague-Dawley

BACKGROUNDIdiopathic pulmonary fibrosis (IPF) is a chronic inflammatory interstitial lung disease with an unknown cause. Recent studies have shown that genetic factors play an important role in the pathogenesis of IPF.

METHODSTo explore the genetic background of patients with IPF, a candidate gene approach was employed to screen for mutations in seven genes among members with familial IPF in mainland of China.

RESULTSWithin six of the candidate genes, a total of 31 point mutations were identified. Among the missense mutations, the SFTPA1 exon 6 CAG > AAG (Gln238Lys) and SFTPB exon 2 CAC > CCC (His2Pro) mutations caused changes in the physical and chemical properties of amino acids. Each sequence alteration was identified in sporadic IPF patients, control specimens (pneumonia patients and healthy persons). Genotype frequencies and allele frequencies of codon 238 in exon 6 of SFTPA1 were noted significantly higher in patients with IPF than those in other two control subjects. The computational protein structure prediction by protein homology modeling confirmed differences in three-dimensional structure between mutant SFTPA1 and original SFTPA1.

CONCLUSIONSAlthough the functions of the mutant candidate genes vary, these genes may ultimately result in damage to alveolar epithelial cells, initiating the progress of pulmonary fibrosis. In particular, while pathophysiological mechanisms need to be illustrated, the Gln238Lys missense variant of exon 6 in the SFTPA1 may have potential susceptibility in the development of IPF, which was shown in patients with sporadic IPF with a statistically higher frequency.

Adult ; China ; Exons ; genetics ; Female ; Gene Frequency ; genetics ; Genetic Predisposition to Disease ; genetics ; Genotype ; Humans ; Idiopathic Pulmonary Fibrosis ; genetics ; Male ; Mutation ; genetics ; Mutation, Missense ; genetics ; Pulmonary Surfactant-Associated Protein A ; genetics

OBJECTIVETo observe the effect of acupuncture at the whole points of Hand Jueyin pericardium meridian on the amplitude of low frequency fluctuations (ALFF) of healthy people in resting state (R1) functional magnetic resonance imaging (fMRI).

METHODSTotally 16 healthy subjects received structure scan of T1 and T2. Then two fMRI scans were conducted for each participant. fMRI included the resting-state scan (R1; the scanning time was 8 min 6 s), the stimulating-acupoint scan (AP; the scanning time was 8 min 6 s). fMRI data acquisition from structure scanning and function scanning were processed with format conversion and statistical analysis.

RESULTSUnder R1 state, brain regions with activated ALFF signals included bilateral superior frontal gyrus, medial frontal gyrus, middle occipital gyrus, precuneus, superior temporal gyrus, and cingulate gyrus. Under the AP state, brain regions with activated ALFF signals were bilateral superior frontal gyrus, medial frontal gyrus, middle temporal gyrus, left fusiform gyrus, precuneus, posterior cingulate, and declivis. Compared with R1 state, obvious difference of ALFF signal areas of the brain caused by acupuncture at pericardium were: bilateral cuneus, precuneus, left posterior cingulate gyrus, right middle occipital gyrus, and right occipital lingual gyrus.

CONCLUSIONAcupuncture at the whole points of Hand Jueyin pericardium meridian could significantly change inherent activity states of the cerebral cortex, especially in bilateral superior frontal gyrus, medial frontal gyrus, and precuneus.

Acupuncture ; Acupuncture Points ; Brain ; physiology ; Brain Mapping ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; methods ; Pericardium

Aged ; Arylsulfotransferase ; genetics ; Aza Compounds ; administration & dosage ; Fluoroquinolones ; Genetic Predisposition to Disease ; Humans ; Male ; Multidrug Resistance-Associated Proteins ; genetics ; Multiple Organ Failure ; chemically induced ; genetics ; Mutation ; genetics ; Quinolines ; administration & dosage