Objective To systemically evaluate the clinical therapeutic effect of combined traditional Chinese medicine (TCM) and western medicine for treatment of acute heart failure by Meta analysis. Methods The America National Library PubMed and China Biomedical Literature Data System (SinoMed), China National Knowledge Infrastructure (CNKI), VIP Data Resource, Wanfang Data Resource, Chinese TCM Database Retrieval System were searched from 1990 to May 2014 to identify the formally published randomized controlled trials (RCTs) in which the effects of combined TCM and western medicine (experiment group) or simple western medicine (control group) for treatment of patients with acute heart failure were reported. The Cochrane system 4.2.2 quality evaluation standard in Evaluation Handbook was applied to assess the methodological quality of literature. The Cochrane Collaboration's RevMan 5.2 software was used to seek the literatures consistent to the criteria of enrolling into the study for Meta analysis. Results There were 18 RCTs, and all together 1 374 cases were included in the data. The grade of methodological quality of the enrolled studies was of high migration. Meta analysis showed: compared with the control group, the clinical efficacy in experimental group was significantly higher [odds ratio (OR) = 5.04, 95% confidence interval (95%CI): 3.31 - 7.69, P < 0.000 01]; the level of type B natriuretic peptide (BNP) was significantly reduced [standardized mean difference (SMD) = -1.31, 95%CI: -1.78 to -0.83, P<0.000 01];left ventricular ejection fraction (LVEF) was significantly increased (SMD=0.79, 95%CI:0.52-1.07, P < 0.000 01); the therapeutic effect on TCM syndrome was significantly elevated [categorical variables: relative risk (RR) = 1.30, 95%CI: 1.06 - 1.59, P = 0.01; quantitative variables: mean difference (MD) = -1.67, 95%CI: -2.48 to-0.86, P<0.000 1] and cardiac diastolic function was significantly improved (SMD=0.64, 95%CI:0.05-1.24, P<0.05). Conclusions The clinical therapeutic effects of combined TCM and western medicine are significantly higher than those of simple western medicine for treatment of patients with acute heart failure. However, the low quality of the reports involved in this study limits the reliability of this conclusion.

Objective To evaluate the efficacy of integrated traditional Chinese medicine(TCM)and western medicine in treatment of acute exacerbations of chronic obstructive pulmonary disease(AECOPD)combined with respiratory failure,TCM syndromes of spleen-kidney-yang deficiency and phlegm-dampness by comparison between the integrated therapy and simple western therapy in treatment of the disease. Methods 160 patients with AECOPD combined with respiratory failure,spleen-kidney-yang deficiency and phlegm-dampness syndrome in the intensive care units(ICU)of Affiliated Hospital of Chengdu University of TCM and other four hospitals were randomly allocated into two groups in this double-blinded,multicenter,prospective,randomized,controlled trial. In the control group (78 cases),western medicine and placebo were given to the patients,and in the treatment group(82 cases), conventional western medicine plus fei-shuai mistura 25 mL were administered,four times per day,the therapeutic course lasting for 2 weeks in both groups. The all-cause mortality,respiratory failure-cause mortality,improvement of modified Medical Research Council(mMRC)Dyspnea Scale grades,6 minutes walk distance(6MWD),the forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)were observed in the 28 days after the end of treatment. Results In the comparisons between the control and treatment groups,there were no statistical significant differences in the all-cause mortality〔54.87%(45/82)vs. 64.10%(50/78)〕and the cases of FEV1/FVC(both P>0.05)in the 28 days after the end of treatment;the 28 day respiratory failure-cause mortality was significantly decreased〔19.51%(16/82)vs. 33.33%(26/78),P<0.05〕,the number of patients with mMRC Dyspnea Scale grades (1-2)was obviously increased(22 cases vs. 7 cases,P<0.05),and the number of patients with 6 MWD grades (4-6)was markedly enhanced in the treatment group(21 cases vs. 8 cases,P<0.05). Conclusions The integrated TCM and western medicine has better therapeutic results in improvement of the patients' degree of dyspnea, 6 MWD and respiratory failure mortality than simple treatment with western therapy for treatment of patients with AECOPD combined with respiratory failure, spleen-kidney-yang deficiency and phlegm-dampness syndrome. However,in regard to the effect on pulmonary function and all cause mortality,the integrated therapy for treatment of such patients in short term has no significant effect.

Objective To investigate the imaging features of the nigrosomes-1 region in the substantia nigra at 3.0 T with enhanced gradient echo T2 star weighted angiography(ESWAN), and to explore its clinical value in the evaluation of Parkinson disease (PD). Methods Fifty-four patients diagnosed with PD (PD group), and 51 non-PD volunteers (N-PD group) were scanned with 3.0 T ESWAN, who had selected randomly. The widths of the typical high signal correspondence with the nigrosomes-1 region (a), the width at the middle of the substantia nigra (b) and the width of the banded high signal of which the oval structure were not displayed (c) were measured and collected. The result of reclassification performed by 2 physicians were compared with clinical gold standard. Specificity and sensitivity were calculated; Eleven outpatients with clinically suspected PD but undiagnosed (UD group) were continusouly selected. They received the same scanning and were performed with imaging diagnosis according to the conclusions of previous studies, then compared the imaging diagnosis with the final clinical diagnosis. Results In non PD group, hyperintensity of nigrosomes-1 were shown in 49 cases (96.1%) in bilateral or unilateral of the SN, the hyperintensity were shaped as“drop”, wedge or oval and the average size (a/b) was (0.31 ± 0.07)mm approximately; PD group, all 54 cases (100.0%) of the oval rear the“drop”were completely disappeared. The sensitivity of the loss of the hyperintensity of nigrosomes-1 for the diagnosis of PD was about 100.0%(54/54)and the specificity of it was about 96.08%(49/51). In UD group, 7 cases with the“drop”completely missed and 1 case with smaller“c”were clinically proven to PD, 2 cases with the typical hyperintensity and 2 case with larger“c”were proven to Parkinson plus syndrome. Conclusions The nigrosomes-1 typical hyperintensity in PD patients' substantia nigra on the 3.0 T ESWAN are disappeared. There may be an effective method for PD and Parkinson's plus syndrome identification that by analyzing of the presence or absence of the typical hyperintensity and its size in the patients with symptoms of PD.

OBJECTIVE: To study the mechanisms of Tongxia Huayu Decoction (a Chinese herbal decoction for purgation and removing blood stasis) in prognostic improvement for severe acute pancreatitis by early intervention on pancreatic microcirculatory disturbance. METHODS: Fifty-three patients with severe acute pancreatitis were divided randomly into treatment group (n=28) and control group (n=25). Tongxia Huayu Decoction was given to the patients in treatment group in addition to the normal treatment in control group for one week. The clinical symptoms and signs, hemodiastase, urinary amylase, C-reactive protein (CRP) and endothelin (ET) of the patients in the two groups before and after treatment were observed and detected. RESULTS: The total response rate of the treatment group was 98.4%, while that of the control group was 80%, with significant difference between them (P<0.05). There was no significant difference of the contents of hemodiastase, urinary amylase, CRP and ET between the two groups before treatment, while they were significantly decreased after treatment (P<0.01) with more obvious change in treatment group (P<0.01). CONCLUSION: Tongxia Huayu Decoction brings satisfied therapeutic effect on severe acute pancreatitis. The mechanisms may associate with its reducing function on ET releasing so as to inhibit the pancreatic microcirculatory disturbance and acinar cell injury induced by ET.

Objective To study the protective effect of warming kidney and subsiding yang traditional Chinese medicine (TCM) method on lung tissues of rats with acute respiratory distress syndrome (ARDS) associated with sepsis. Methods Eighty healthy male Wistar rats were divided into normal control group, model group and low, medium and high dose Fusuheji groups by random number table, 16 rats in each group. The acute lung injury (ALI) model was established by injecting lipopolysaccharide (LPS) 3 mg/kg into a rat caudal vein within 5 minutes, and the normal control group was given the same volume of normal saline. Then the low, medium and high dose TCM groups were given low, medium and high dose Fusuheji TCM mixture (the ingredients of the mixture: radix aconite lateralis preparata 30 g, oysters 30 g, ginger 15 g, ephedra 15 g, licorice 10 g) 2.625, 7.875, 10.500 g/kg intragastric administration respectively. Equal volume of saline was given to the normal control group and model group by gavage. At 24 and 48 hours after respective administration, 8 rats were taken from each group to observe the pathological changes of lung tissues and score the lung injury. The rates of survival of rats were calculated after the experiment in various groups. Results After administration for 48 hours, the survival rate of rats in model group was obviously lower than that of the normal control group [18.7% (3/16) vs. 100.0% (16/16)], the low, middle and high dose Fusuheji groups' survival rates were all significantly higher than the rate of ALI model group [50.0% (8/16), 75.0% (12/16), 93.7%(15/16) vs. 18.7% (3/16), all P < 0.05]. There were no pathological changes in the lung tissues of rats in the normal control group, large amounts of exudates and hemorrhages were present in the lung tissues of ALI model group, and the inflammatory, exudative and hemorrhagic changes of lung tissues in the high, middle and low dose Fusuheji groups were obviously improved. After administration for 24 hours and 48 hours, the lung injury scores in the ALI model group were higher than those in control group (after administration for 24 hours: 7.83±0.60 vs. 2.89±4.23; after administration for 48 hours: 7.33±0.88 vs. 3.00±0.28), the scores of lung injury of any Fusuheji drug group were significantly lower than those of ALI model group, and the degrees of decrease were more marked in high dose Fusuheji group than those in low and middle dose Fusuheji groups (after administration for 24 hours: 3.37±0.32 vs. 6.00±0.44, 4.63±0.50; after administration for 48 hours: 3.25±0.25 vs. 5.25±0.25, 3.50±0.50). Conclusion The warming kidney and subsiding yang TCM method can improve the lung tissue injury in ARDS associated with sepsis in rats, promote the damaged lung tissue to recover, and ultimately the prognosis of ARDS rats is getting better.

In recent years, with the development of bone marrow and organ transplantation, cytomegalovirus (CMV) has become a common pathogen threatening patients having undergone organ transplantation. CMV may cause severe pulmonary infection and respiratory failure, leading to the death of patient with CMV pneumonia. CMV infectious pneumonia is characterized by the formation of huge type A eosinophil inclusion bodies in the nucleus and cytoplasm of the infected cells. The susceptible population is often associated with low immune function, and to promote the recovery of autoimmune function is the key point for treatment of CMV pneumonia, and the plasma exchange therapy can reconstruct the autoimmune function and improve the prognosis of patients with CMV pneumonia to a certain extent. Now the experience of 1 patient of severe CMV pneumonia treated by ECMO combined with plasmapheresis is reported.

Objective To analyze the distribution of traditional Chinese medicine (TCM) syndromes and characteristics of patients with acute respiratory distress syndrome (ARDS), and to provide reference for further clinical study of ARDS. Methods The clinical data of ARDS patients admitted to the Department of Critical Care Medicine of Affiliated Hospital of Chengdu University of TCM from November 2017 to February 2019 were retrospectively analyzed. The general data (gender and age) and inducing cause of disease, clinical manifestations, intensive care unit (ICU) stay time, total hospitalization time, outcome in ICU, outcome in 28-day follow-up and TCM syndromes were recorded. The different degrees of disease severity, the clinical manifestations and distribution characteristics of TCM syndromes were analyzed. Results A total of 110 patients with ARDS were enrolled, including 2 patients in mild ARDS group, 33 patients in moderate ARDS group and 75 patients in severe ARDS group. In the etiology analysis of ARDS, infection was the commonest cause, including 46 cases of pulmonary infection (41.8%), 27 cases of sepsis (24.5%), 4 cases of abdominal cavity infection (3.6%), 2 case of urinary tract infection (1.9%), and 13 cases had surgical histories (11.8%). The stay in ICU was 9.00 (3.00, 18.00) days and the total hospital stay was 18.00 (10.00, 30.00) days. The mortality in ICU was 32.7% (36/110), and that in 28-day follow-up was 60.0% (66/110). The clinical symptoms of the patients in moderate and severe groups ARDS were mainly dyspnea, cough, fever, sputum, chest tightness, and palpitations, accounting for 75.0% (81/108), 43.5% (47/108), 28.1% (31/108), 26.9% (29/108), 22.2% (24/108) and 25.9% (28/108), respectively. Compared with the ARDS moderate group, the proportions of patients with dyspnea, cough and palpitation in severe ARDS group were significantly higher [80.0% (60/75) vs. 63.6% (21/33), 50.7% (38/75) vs. 27.3% (9/33), 33.3% (25/75) vs. 9.1% (3/33), respectively, all P < 0.05]. The main TCM syndromes were yang deficiency, exuberant heat-toxin, and wind-heat invading lung, accounting for 53.7% (58/108), 28.7% (31/108), and 25.0% (27/108) respectively. The proportion of patients with exuberant heat-toxin syndrome in severe ARDS group was obviously higher than that in the moderate ARDS group [34.7% (26/75) vs. 15.2% (5/33), P < 0.05], while the proportion of patients with wind-heat invading lung syndrome in moderate ARDS group was more than that in the severe ARDS group [42.4% (14/33) vs. 17.3% (13/75), P < 0.05]. Conclusion ARDS is a critical illness with high mortality and various complicated clinical symptoms, the TCM syndromes of ARDS are mainly yang deficiency, exuberant heat-toxin, wind-heat invading lung, and intermingling of deficiency and excess easily leading to collapse syndrome.

Objective To evaluate the present development and status of quality control for intensive care unit (ICU) in Sichuan Provincial traditional Chinese medicine (TCM) hospitals including integrated traditional Chinese and western medicine hospitals and ethnic hospitals, and to provide practical references for improving the service quality of ICU. Methods Supervisory Group of Sichuan Provincial Critical Care Medicine Quality Control Center of TCM was established in September 2018. From September 8th to 17th, 2018, according to the Scoring Criteria of Quality Control and Supervision Project of TCM for Critical Care Medicine, a 10-day quality control professional guidance was hand out to TCM hospitals with independent ICU in Sichuan Province. The service level of different aspects of hospital quality control was evaluated and ranked from equipment and resource support, medical team, service capacity and level, ward quality, completion of critical care core indicators, completion of quality control of TCM, development of new technologies, diagnosis and treatment schemes for dominant diseases. Results There were 52 TCM hospitals across the province that had an ICU. Thirty-three hospitals were third-class (63.5%), while the rest 19 hospitals were second-class (36.5%). Province-level, city-level and county-level hospitals were accounted for 9.6% (5/52), 38.5% (20/52), and 51.9% (27/52), respectively. Average bed ratio of ICU was 1.8%. Doctor-bed and guard-bed ratios were 0.71∶1 and 2.0∶1, respectively. The average annual admission rate of patients and the average daily admission rate of beds were higher, which were basically 1%. Ward quality was high; the incidence of nosocomial infection was controlled below 10%. Compliance rate of septic shock bundle treatment was high. The incidences of ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) were 0.45%, 0.22%, and 0.30%, respectively. Participation rate of TCM was about 83.4%. Average number of new technologies was about 4.4. Average number of disease schemes was about 2.62. Conclusions ICU of Sichuan Provincial TCM hospitals reaches the standard level in service capacity and level, ward quality, critical medicine quality control, and participation rate of TCM treatment. Improvements are required for other prospects, including department scale, medical personnel allocation, new technical development, diagnosis and treatment schemes of dominant diseases.

Objective:To analyze the distribution characteristics of traditional Chinese medicine (TCM) syndromes in patients with coronavirus disease 2019 (COVID-19) in plateau areas, and to provide theoretical basis for further clinical treatment of patients with COVID-19.Methods:From August 9 to August 24, 2022, patients with COVID-19 admitted to the Third People's Hospital of Tibet Autonomous Region (designated hospital for COVID-19) were included, and their baseline characteristics (age, gender, source), clinical classification and distribution of TCM syndrome types were collected and analyzed. Data analysis was performed using SPSS 26.0 statistical software.Results:A total of 161 COVID-19 patients were enrolled with ethnic distribution: 124 (77.02%) Tibetans, 35 (21.74%) Han, and 2 (1.24%) Hui, 68 males and 93 females. The male-to-female ratio was 0.73∶1. Aged 1 to 94 years, the average age was (39.06±23.64) years old, of which 4 patients were under 1 year old (excluded because the information was missing). A total of 157 patients were enrolled, and 124 patients (78.9%) were under 60 years old, including 120 cases of common type, 4 cases of severe type, 0 cases of critical type, 7 cases over 80 years old, 1 case over 90 years old, and 32 cases under 18 years old. The clinical manifestations of the patient are mainly cough, expectoration, fever, aversion to cold, dry throat, headache, fatigue, running nose, dry mouth, bitter mouth, etc. Most of the tongue is pale, red, and white greasy moss or thin white coating. In TCM, the most common syndrome was cold-dampness blocking lung syndrome (99 cases, 63.06%), followed by cold-dampness stagnant lung syndrome (22 cases, 14.01%), damp-heat accumulating lung syndrome (22 cases, 14.01%), and humidity stagnant lung syndrome (11 cases, 7.01%). Syndromes of epidemic (2 cases, 1.27%), epidemic toxins blocking the lung pattern (1 cases, 0.64%), toxins with dryness intense heat in both qi and ying phases pattern (0 cases) accounted for less than 2%, and the distribution of various syndrome types in COVID-19 patients was uneven ( χ2 = 0.48, P < 0.05). Conclusion:The most common TCM syndromes of COVID-19 patients in Lhasa are cold-dampness blocking lung syndrome, followed by cold-dampness stagnant lung syndrome, damp-heat accumulating lung syndrome, and humidity stagnant lung syndrome.

Background: and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. Methods: This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. Results: Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.