Based on the viewpoints of turbidity and toxin and years of clinical experience,professor Wei Aisheng proposed that spleen qi deficiency leading to internal retention of turbidity and toxin contributes to the key pathogenesis of patients with type 2 diabetes mellitus(T2DM)characterized by obesity or metabolic disorders.For T2DM patients with obesity or metabolic disorders in the middle and end stages,long-term retention of turbidity and toxin leads to unsmooth qi movement of triple energizer and damage of viscera.Therefore,Professor Wei put forward the viewpoint of cutting off the toxin in the early stage,and established the therapy of replenishing qi,respectively expelling pathogens and eliminating turbidity from triple energizer.Professor Wei formulated Sanhuang Yinchen Wuling San as the primary prescription for T2DM.The prescription is derived from the classical formula Yinchen Wuling San with the herbs of Astragali Radix,Coptidis Rhizoma and Ephedrae Herba added,having the actions of replenishing qi and supporting healthy qi,respectively expelling pathogens from triple-energizer to resolve phlegm-damp and stagnated heat.The application of Sanhuang Yinchen Wuling San for T2DM can invigorate spleen qi,smooth qi movement of triple energizer,and eliminate turbidity and toxin,and enhance the efficacy for T2DM.

Objective To observe the therapeutic effects and mechanisms of acupuncture at Renying(ST9)on hypertension.Methods Spontaneously hypertensive rats(SHRs)were randomly divided into a model group and a Renying group 6 rats in each group,with six Wistar-Kyoto(WKY)rats serving as the blank control group.The Renying group received bilateral acupuncture at Renying point once daily for 5 consecutive days,followed by a 2-day rest,for a total of 4 weeks.Systolic and diastolic blood pressures were measured via tail-cuff plethysmography before intervention and at weeks 1,2,3,and 4 after intervention.After the intervention,fecal and plasma samples were collected.16S rDNA high-throughput sequencing was used to analyze gut microbiota composition,and 1H NMR spectroscopy was employed to detect plasma metabolite differences.Results(1)Before intervention,systolic and diastolic blood pressures in the model and Renying groups were significantly higher than those in the blank group(P＜0.05).After acupuncture intervention,the Renying group exhibited significantly lower systolic and diastolic blood pressures than the model group at weeks 2,3,and 4(P＜0.05).After 4 weeks,the model group showed significantly increased systolic and diastolic blood pressures compared with baseline(P＜0.05),whereas the Renying group exhibited significantly decreased pressures(P＜0.05).Throughout the intervention,the Renying group demonstrated smaller blood pressure fluctuations and more stable control than the model group.(2)Microbiota analysis:Compared with the blank group,the model group had 39 fewer unique operational taxonomic units(OTUs),whereas the Renying group showed increased unique OTUs,approaching levels observed in the blank group.(3)NMDS analysis of β-diversity revealed that acupuncture significantly altered gut microbial diversity in SHRs.At the phylum level,Firmicutes,Bacteroidetes,Verrucomicrobia,and Patescibacteria dominated gut microbiota composition.Patescibacteria abundance was significantly increased in the model group but decreased in the Renying group(P＜0.05).At the genus level,Bacteroides and Faecalibacterium abundances were reduced in the model group but higher in the Renying group(P＜0.05).(4)LEfSe analysis indicated significant enrichment of Clostridia_vadinBB60_group and Alistipes_sp_CHKCI003 in the Renying group,whereas unclassified_Clostridia_UCG_014 was more prevalent in the model group.(5)OSC-PLS analysis of 1H NMR-detected plasma metabolites revealed significant intergroup differences,with Renying acupuncture altering acetate and trimethylamine N-oxide(TMAO)levels.Conclusion Acupuncture at Renying points significantly reduces systolic and diastolic blood pressures in SHRs,possibly by modulating gut microbiota structure,ameliorating microbial dysbiosis,promoting beneficial bacterial growth,suppressing harmful bacteria,and regulating acetate-and TMAO-related metabolic pathways.

Objective To investigate the changes of blood lipid and glycosylated hemoglobin (HbA1c) levels in obese type 2 diabetes (T2DM) patients and their relationship with insulin resistance (Homa-IR). Methods A total of 120 cases of T2DM newly diagnosed in Motuo County, Tibet from February to October 2022 were selected as the observation group. According to BMI, the patients were divided into diabetes normal weight group (46 cases), overweight group (43 cases) and obesity group (31 cases); 145 healthy subjects were selected as the control group. The levels of HbA1c, fasting blood glucose (FPG), fasting insulin (FINS), serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) were detected in the study subjects, and Homa-IR and Homa-β indices were calculated. The height, weight, and abdominal circumference were measured. The differences in the levels of the above indicators between the observation group patients and the control group, as well as among various subgroups within the observation group were compared. The influencing factors of Homa-IR in obese T2DM patients were analyzed. Results Compared with the control group, a significant increase in BMI, abdominal circumference, blood pressure, HbA1c, FBG, FINS, TC, TG, LDL-C, UA, visceral fat area, and the levels of Home-IR and Home-β was found in the observation group (all P<0.05). There were significant differences in BMI, abdominal circumference, and the levels of FINS, Homa IR, Homa-β, and HbA1c in diabetes patients with different BMI (all P<0.05). Correlation analysis showed that TG levels in obese T2DM patients in the observation group were significantly correlated with HbA1c (r=0.396, P=0.027), Homa-IR (r=0.405, P=0.024), and Home-β (r=-0.401, P=0.025); LDL-C was significantly correlated with Homa-IR (r=0.411, P=0.022) and Homa-β (r=-0.412, P=0.021); HbA1c was significantly positively correlated with BMI (r=0.371, P=0.040). Conclusion Insulin resistance is closely related to TG, LDL-C, and BMI in obese T2DM patients from the Motuo ethnic minority of Tibet, suggesting that these factors may play a role in the occurrence of T2DM.

OBJECTIVETo compare the efficacy differences between moxibustion at Geshu (BL 17) and oral administration of cilostazol on diabetic limb arterial obliteration (DLAO) at early stage as well as the impacts on hemorheology and arterial inner dimension of lower extremity.

METHODSSeventy patients of DLAO at early stage were randomly divided into an observation group and a control group, 35 cases in each one. The two groups were treated with regular treatment of blood glucose and blood lipid. The patients in the control group was treated with oral administration of cilostazol, 50 mg, twice a day; the patients in the observation group were treated with moxibustion at Geshu (BL 17), once a day. The consecution treatment of two weeks constituted one session, and totally 4 sessions were given. The total syndrome score, hemorheology index (including low and high shear viscosity of blood, plasma viscosity, hematocrit and erythrocyte aggregation index) and arterial inner dimension of lower extremity (including popliteal artery, posterior tibial artery and dorsalis pedis artery) were compared before and after treatment.

RESULTSCompared with those before treatment, the total syndrome score, hemorheology index and arterial inner dimension of lower extremity were significantly improved after treatment in the two groups (all<0.05). The total syndrome score, hemorheology index in the observation group were superior to those in the control group (all<0.05), but the improvement of arterial inner dimension of lower extremity was not significantly different between the two groups (>0.05). After treatment, the total effective rate was 91.4% (32/35) in the observation group, which was significantly superior to 85.7% (30/35) in the control group (<0.05).

CONCLUSIONMoxibustion at Geshu (BL 17) is superior to oral administration of cilostazol for DLAO at early stage, which could effectively improve the clinical symptoms, blood flow and blood vessel and increase the blood flow of lower limb.

Objective To investigate the nutritional status of elderly patients with diabetic foot ulcers and to explore its influencing factors and relationship.Methods Convenience sampling method was used to recruit 182 elderly patients with diabetic foot ulcers.The mini nutritional assessment (MNA) was adopted to assess nutritional status,and patients' clinical information,hemoglobin A1c,hemoglobin,serum albumin,C-reactive protein were also collected.Results The average score of MNA was 16.36±3.68 for 182 patients,and 121 patients suffered from malnutrition(66.48％),while 61 patients suffered from potential malnutrition(33.52％).The occurrence of malnutrition was positively correlated with age,course of diabetes,classification of foot ulcer,infection,C-reactive protein,hemoglobin A1c and food intake (P＜0.05);the incidence of malnutrition and C-reactive protein for patients with Wagner grade 3 and above were higher than those for patients with low Wagner grades,and hemoglobin A1c and hemoglobin were lower for patients with Wagner grade 3 and above(P＜0.05).Conclusion There was high incidence rate of malnutrition in elderly patients with diabetic foot ulcers,closely related to inflammatory state.Health care providers should provide targeted interventions in time,improve condition of malnutrition,and promote rehabilitation.

OBJECTIVETo compare the efficacy between acupuncture at stellate ganglion combined with intravenous administration of alprostadil and simple intravenous administration of alprostadil on lower limb atherosclerosis of early diabetes mellitus.

METHODSSixty patients of lower limb atherosclerosis of early diabetes mellitus were randomly divided into an observation group and a control group, 30 cases in each one. Patients in the two groups were treated with basic treatment to control blood glucose and lipid. In addition, patients in the control group were treated with intravenous administration of alprostadil (10 µg) and sodium chloride solution (100 mL); based on this, patients in the observation group were treated with acupuncture at stellate ganglion. The treatment was given once a day; the consecutive treatment of two weeks constituted one session, and totally 4 sessions were given. The total syndrome score, glycosylated hemoglobin (HbA1c), blood flow of posterior tibial artery and dorsal artery of foot were observed before and after treatment; the clinical efficacy was compared between the two groups.

RESULTSCompared before treatment, the total syndrome score, HbA1c, blood flow of posterior tibial artery and dorsal artery of foot were significantly improved after treatment (all P < 0.05), which were more obvious in the observation group (all P < 0.05). After treatment, the total effective rate was 93.3% (28/30) in the observation group, which was significantly superior to 86.7% (26/30) in the control group (P < 0.05). CONCLUSION Acupuncture at stellate ganglion combined with intravenous administration of alprostadil achieve better effect than simple intravenous administration of alprostadil for lower limb atherosclerosis of early diabetes mellitus, which improve the clinical symptoms, regulate blood sugar and increase the blood flow of lower limb.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Atherosclerosis ; etiology ; physiopathology ; therapy ; Diabetes Mellitus, Type 2 ; complications ; Female ; Humans ; Lower Extremity ; blood supply ; innervation ; physiopathology ; Male ; Middle Aged ; Stellate Ganglion ; physiopathology ; Treatment Outcome

Objective To understand Shenzhen Longgang,guangming and longhua new district four district hospital ICU pa-tients with secondary pulmonary tuberculosis merger lower respiratory infection of pathogenic bacteria distribution and drug resistance status of provide a reference for clinical diagnosis and rational use of antibiotics therapy.Methods Random selec-tion from February 2013 to October 2015 in the three district hospital ICU diagnosis of secondary pulmonary tuberculosis patients with lower respiratory infection in 593 cases of sputum specimen pathogenic bacteria culture and drug susceptibility results were retrospectively analyzed.Results 593 cases of ICU secondary pulmonary tuberculosis patients with respiratory tract infection of the communist party of China isolated 617 strains of pathogenic bacteria,fungi accounted for 49.6% (306/617),gram negative bacilli accounted for 40.4% (249/617),gram positive cocci accounted for 10.0% (62/617).Fungal in-fection main pathogens for white smooth candida yeast and candida yeast,respectively accounted for 44.2% (273/617)and
4.5% (28/617),gram negative bacillus mainlyKlebsiellaPneumoniae,Pseudomonasaeruginosa,and H.influenzae,respec-tively accounted for 16.7% (103/617),12.0% (74/617)and 7.3% (45/617),gram-positive cocci mainly for Saphylococcus aureus and Epidermisstaphylococcus and Hemolyticstaphylococci,respectively accounted for 4.5% (28/617),3.2% (20/617)and 0.9% (5/617).Pathogenicbacteria isolated from the multiple drug resistant bacteria,present different levels of resistance to commonly used antimicrobial agents.Conclusion ICU patients with secondary pulmonary tuberculosis merger of lower respiratory tract infection pathogens to fungi and gram-negative bacilli,the most commonWhite candida,Klebsiella pneumoniae,and Pseudomonasaeruginosa,and different levels of resistance to commonly used antimicrobial agents.

Objective:To detect anaemia parameter methodology performance for validation of Roche Cobas E601 automatic electrochemical luminescence immunity analyzer.Methods:Recommended by the American association of clinical laboratory standardization (CLSI) method was developed for the determination of folic acid, iron, protein, and this precision, accuracy, linear range, sensitivity, biological reference range and carry pollution index, and validated.Results: Cohas E601 determination of folic acid, iron, protein and precision, the daytime in this batch variation coefficient were 3.03%~4.27% and 3.51%~4.68%. Relative bias must lean on(%) between -3.54%~4.46%. The scope of determination of linear range and the manufacturer to provide similar. Folic acid, iron, protein and numerical value with the determination of this instrument manufacturers provide reference interval coincidence rate were 90.0%, 85.0% and 90.0% respectivel. Instrument to detect carry pollution rate is 0.04%~0.16%. CohasE601 detection sensitivity were 0.23 ng/ml, 0.21 ng/ml and 0.19 pg/ml.Conclusion: Cobas E601 detect folic acid, iron, protein and good performance of this methodology, but manufacturers provide biological reference range is not suitable for the local crowd, should establish the corresponding normal reference range.

Objective To explore the clinical application of jiont detection of critical patients procalcitomin (PCT)and (1,3)-beta D-glucan with deep fungus infection in ICU.Methods From November 2012 to August 2014 diagnosed with deep fun-gal infection of ICU critical patients,106 cases of patients with serum PCT and (1,3)-beta-D glucan content detection,and ICU of deep fungal infection in critically ill patients,519 cases were analyzed,with differencesbetween the paired t test to compare the results.Results 106 patients with deep fungal infection of ICU critical patients serum PCT for 0.701 ±0.22 pg/ml and (1,3)-beta-D glucan for 37.82±18.43 pg/ml,significantly higher than the 519 cases of ICU of deep fungal infec-tion in critically ill patients in the serum PCT for 0.238±0.12 pg/ml and (1,3)-beta-D glucan for 14.96 ±4.37 pg/ml, comparing differences between both results was statistically significant (t=7.426,8.179,P <0.05).106 patients with deep fungal infection of ICU critical patients serum PCT positive detection rate was 57.5% (61/106),significantly lower than the (1,3)-beta-D glucan positive detection rate 89.6% (95/106),difference was statistically significant (χ2 = 13.645,P <0.05).Conclusion Deep fungal infection in critical care patients in the ICU in the serum PCT and (1,3)-beta-D glucan con-tent of deep fungus infection in critically ill patients was significantly higher than the ICU,PCT and (1,3)-beta-D glucan joint detection of deep fungal infection in patients with ICU critical patients diagnosis has important clinical significance.

Objective To investigate the mixed protamine zinc recombinant human insulin lispro injection on glucose metabolism, immune function in patients with type 2 diabetes and its inflammatory mechanisms.Methods 125 patients enrolled were randomly divided into two groups according to the random number table: control group (n =61) and observation group (n =64).The control group were received conventional treatment, observation group were received mixed protamine zinc recombinant human insulin lispro injection on the basis of control group, with a course of three months of both groups.The fasting blood glucose (FBG), 2h post prandial blood glucose (2hPG), glycated hemoglobin (HbA1c), fasting insulin, insulin resistance index ( IRI) , CD4 +, CD8 +, CD4 +/CD8 +changes and inflammatory cytokines levels were compared before and after treatment between two groups. Results The level of FBG, 2hPG, HbA1c after treatment was respectively lower than that before treatment in both groups (P<0.05), and the above indexes of observation group after treatment was respectively lower than that of control group (P<0.05).The level of fasting insulin, IRI after treatment was respectively lower than that before treatment in both groups (P<0.05), and the above indexes of observation group after treatment was respectively lower than that of control group (P<0.05).The level of CD8 +was lower, CD4 +, CD4 +/CD8 +was higher after treatment than that before treatment in both groups, respectively (P<0.05), and the CD8 +level of observation group after treatment was lower, CD4 +, CD4 +/CD8 +was higher than that of control group, respectively (P<0.05).The level of TNF-α, IL-6, CRP after treatment was respectively lower than that before treatment in both groups (P<0.05), and the above indexes of observation group after treatment was respectively lower than that of control group (P<0.05).Conclusion The mixed protamine zinc recombinant human insulin lispro injection can significantly improve glucose metabolism in patients with type 2 diabetes, and enhance immune function, reduce inflammation, thereby reducing the incidence of cardiovascular events.