The occurrence of diabetes mellitus （DM） is closely related to insulin resistance and islet β cell dysfunction. Modern studies have found that macrophages are widely present in the liver，fat，skeletal muscle，islets， and other tissues and organs. Macrophage M1/M2 polarization plays an important role in the occurrence and development of diabetes mellitus and its related complications by intervening in inflammatory response，improving insulin resistance，and promoting tissue repair. Most of the traditional Chinese medicines that regulate the activation and polarization of macrophages are Qi-replenishing and Yin-nourishing，heat-clearing， and detoxicating medicinal，which are consistent with the etiology and pathogenesis of diabetes and its related complications. Therefore，by summarizing the mechanisms between macrophage activation，polarization， and insulin resistance in various tissues，this paper reviewed traditional Chinese medicine and its effective components and compounds in improving diabetes mellitus and its related complications through multi-channel regulation of macrophage polarization and regulation of M1/M2 ratio，providing references for the future treatment of DM and its related complications with traditional Chinese medicine.

The theory of "linkage between spleen and small intestine" has been put forward by doctors as early as the Ming dynasty. In traditional Chinese medicine， the spleen and small intestine cooperate and work together physiologically， and they are also closely related and interact with each other pathologically. The spleen governs transportation and transformation， which involves the function of the small intestine in transforming water and grain. The small intestine， governing the receiving and transformation of substances， depends on the normal transportation of the spleen. At the same time， it provides guarantee for the spleen to transform Qi and generate blood as well as ascend lucidity and descend turbidity. The dysfunction of spleen in transportation is closely related to the dysfunction of small intestine. The stability of intestinal microecology necessitates the normal functioning of the spleen. When the original balance of intestinal flora is disturbed， the spleen functioning will be affected. This study explored the pathogenesis and treatment of diabetes based on the physiological functions of the spleen and small intestine and the Western medicine targets of "nutrients-intestinal flora". According to modern medicine， nutrients are essential to maintain the normal physiological activities of the human body. Proper intake of nutrients can affect the absorption and metabolism of the human body for nutrients by regulating the composition and function of intestinal flora， so as to prevent the occurrence of diabetes. The imbalance of intestinal flora which harbors rich microorganisms may lead to the disturbance of energy metabolism and the dysfunction of the immune system， eventually leading to diabetes. As a metabolic disease， diabetes is closely related to the imbalance of intestinal flora and nutrient intake. Based on the theory of "linkage between spleen and small intestine"， this paper discusses the relationship between spleen and small intestine. Furthermore， this paper discusses the correlation between "spleen-small intestine" and "nutrients-intestinal flora" by reviewing the latest progress in modern medicine and clinical research， aiming to provide a theoretical basis and new ideas for the clinical prevention and treatment of type 2 diabetes mellitus.

Objective:To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics.Methods:The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized.Results:A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360).Conclusions:The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.

OBJECTIVE: To analyze the clinical characteristics and pregnancy outcomes of pregnant women complicated with coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 3 pregnant women with COVID-19 admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 19 to February 10, 2020 were retrospectively analyzed. RESULTS: There was one case in the first-trimester pregnancy (case 1), one in the second-trimester pregnancy (case 2) and one in third-trimester pregnancy (case 3). Cough, fever, fatigue, lung imaging changes were the main manifestations. The white cell count, lymphocyte percentage had no significantly changes in case 1 and case 3, while the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), IL-6 and IL-10 elevated. The lymphocyte count and lymphocyte percentage decreased and the inflammatory indicators significantly increased in case 2. All patients were treated with antiviral, antitussive, oxygen inhalation; case 3 received glucocorticoids, case 2 with severe illness received glucocorticoids and additionally gamma globulin. All three cases were cured and discharged. Case 1 with early pregnancy chose to terminate pregnancy after discharge; case 2 chose to continue pregnancy without obstetric complications; and case 3 had cesarean section delivery due to abnormal fetal heart monitoring. CONCLUSIONS The report shows that COVID-19 in pregnancy women could be cured with active treatment, and the maternal and fetal outcomes can be satisfactory.
Antiviral Agents ; therapeutic use ; Betacoronavirus ; isolation & purification ; Cesarean Section ; Coronavirus Infections ; complications ; drug therapy ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Oxygen ; therapeutic use ; Pandemics ; Pneumonia, Viral ; complications ; drug therapy ; Pregnancy ; Pregnancy Complications, Infectious ; drug therapy ; pathology ; Pregnancy Outcome ; Retrospective Studies ; Treatment Outcome ; gamma-Globulins ; therapeutic use

The access negotiations of National Reimbursement Drug List (NRDL) in China from 2017 to 2019 effectively improved the availability and affordability of high-value innovative drugs. However,the actual outpatient reimbursement of most negotiated drugs is lower,which affects the patients" health insurance funds. In this paper,97 negotiated drugs in 337 overall planning cities were selected as samples to analyze the outpatient reimbursement for negotiated drugs. The results showed that the reimbursement level of 40 negotiated drugs was less than 50% in over 70% cities,which can be mainly interpreted as absence or imperfection of outpatient reimbursement policies for special diseases. Finally,this paper puts forward suggestions and protocols for improving the outpatient medical insurance through realizing outpatient overall planning,improving outpatient reimbursement policies for special diseases,and exploring innovative payment,ensuring the achievement of the access to NRDL.

Objective:To observe the changes of blood cell count, and levels of hormone, glucose, and electrolytes at adrenocorticotrophic hormone (ACTH) and thyrotropic hormone (TSH) axes in patients with traumatic brain injury (TBI) at early stage, and explore the correlations among these indicators.Methods:Prospective selection of 93 patients with TBI (TBI group), admitted to our hospital from March 2018 to July 2019, and 18 health subjects accepted physical examination (control group) during the same period was performed. TBI patients were divided into mild, moderate, and severe subgroups according to Glasgow coma scale (GCS) scores at admission. The changes of blood cell count, and levels of hormone, glucose, and electrolytes of these TBI patients and the control subjects were detected on the 2 nd, 8 th, and 15 th d of TBI. Results:(1) The cortisol (COR) level in TBI group was significantly higher than that in control group on the 2 nd and 8 th d of TBI (P<0.05); COR level in TBI group was decreased on the 2 nd, 8 th, and 15 th d of TBI, successively. TSH level in the TBI group was significantly lower than that in control group on the 2 nd d of TBI; TSH level in patients from the TBI group on the 8 th and 15 th d of TBI was significantly higher than that on the 2 nd d of TBI (P<0.05). Triiodothyronine (T3) level in the control group, and mild, moderate, and severe TBI subgroups decreased successively on the 2 nd d of TBI; and T3 level in TBI group was significantly lower than that in the control group on the 8 th and 15 th d of TBI; T3 level in the TBI group on the 15 th d of TBI was significantly higher than that on the 2 nd and 8 th d of TBI (P<0.05). Tetraiodothyronine (T4) level in the control group, and mild, moderate, and severe TBI subgroups decreased successively on the 2 nd d of TBI; and T4 level in the control group was significantly higher than that in the mild and severe TBI subgroups on the 8 th d of TBI(P<0.05); patients in the severe TBI subgroup had increased T4 level successively on the 2 nd, 8 th, and 15 th d of TBI. Free triiodinated thyroxine (FT3) level in the control group, and mild, moderate and severe TBI subgroups decreased successively on the 2 nd d of TBI; and FT3 level in the TBI group was significantly lower than that in the control group on the 8 th and 15 th d of TBI; FT3 level in TBI group on the 15 th d of TBI was significantly higher than that on the 2 nd and 8 th d of TBI (P<0.05). Free tetraiodothyronine (FT4) level in the control group and moderate TBI subgroup was significantly higher than that in the mild and severe TBI subgroups on the 2 nd and 8 th d of TBI (P<0.05). (2) The white blood cell (WBC) count of the TBI group was significantly higher than that of the control group on the 2 nd d of TBI (P<0.05); the WBC count in the moderate TBI subgroup, severe TBI subgroup, mild TBI subgroup and control group decreased, successively, on the 8 th d of TBI; the WBC count in the severe TBI subgroup, mild TBI subgroup, moderate TBI subgroup and control group decreased, successively, on the 15 th d of TBI; the WBC count in the patients of mild TBI subgroup on the 8 th and 15 th d of TBI was significantly lower than that on the 2 nd d of TBI, and that in patients of moderate and severe TBI subgroups on the 15 th d of TBI was significantly lower than that on the 2 nd and 8 th d of TBI (P<0.05). The red blood cell (RBC) count in the mild, moderate, and severe TBI subgroups, and control group were increased, successively, on the 2 nd, 8 th, and 15 th d of TBI. The platelet (PLT) count in the TBI group was significantly lower than that in the control group on the 2 nd d of TBI, and the PLT count in the mild and moderate TBI subgroups, and control group was significantly lower than that in the severe TBI subgroup on the 15 th d of TBI (P<0.05); the PLT count in the TBI group increased successively on the 2 nd, 8 th, and 15 th d of TBI. The blood glucose level in the control group, and mild, moderate and severe TBI subgroups increased, successively, on the 2 nd d of TBI, and the blood glucose in the severe TBI subgroup was statistically higher than that in the control group on the 8 th d of TBI; the blood glucose level in the TBI subgroup decreased, successively, on the 2 nd, 8 th, and 15 th d of TBI. Potassium level in the mild, moderate and severe TBI subgroups was significantly higher than that in the control group on the 15 th d of TBI; significantly higher potassium level on the 8 th and 15 th d of TBI was noted than that on the 2 nd d of TBI in patients from the moderate and severe TBI subgroups (P<0.05). The sodium content in the severe TBI subgroup was significantly higher than that in the mild and moderate TBI subgroups and control group on the 2 nd d of TBI; the sodium content in the severe TBI subgroup was statistically lower than that in the control group on the 15 th d of TBI (P<0.05). In patients from the severe TBI group, the sodium and chlorine contents on the 8 th and 15 th d of TBI were significantly lower than those on the 2 nd d of TBI. The blood calcium content in the moderate TBI subgroup and control group was significantly higher than that in the mild and severe TBI subgroups on the 2 nd d of TBI, and the calcium content in the severe TBI subgroup was significantly lower than that in the control group on the 15 th d of TBI; calcium content in the mild and severe TBI subgroups on the 8 th and 15 th d of TBI was significantly higher than that on the 2 nd d of TBI ( P<0.05). (3) In TBI patients, WBC count and blood glucose level were positively correlated with COR, and negatively correlated with TSH, T3 and FT3 levels ( P<0.05). RBC count was negatively correlated with TSH level, and positively correlated with FT4 level ( P<0.05). PLT count was negatively correlated with COR and positively correlated with ACTH, TSH, T3, T4 and FT3 levels ( P<0.05). Potassium was positively correlated with TSH, T3, T4, FT3 levels, and negatively correlated with COR ( P<0.05). Sodium was negatively correlated with TSH, T4, FT3 and FT4 levels, and positively correlated with COR ( P<0.05). Chlorine was negatively correlated with COR, TSH, T4, FT3 and FT4 levels ( P<0.05). Calcium was positively correlated with T3, T4, FT3 and FT4 levels ( P<0.05). Conclusions:The more severe the injury of TBI patients, the more significant the decline of T3, FT3, and FT4 levels and RBC count, and the more significant the increase of WBC count and glucose level. Most of them gradually returns to normal within one-2 weeks of injury. It is recommended to evaluate ACTH axis and TSH axis functions when blood cell count, glucose, and electrolytes are abnormal after TBI.

To investigate the role of cardiac magnetic resonance imaging (CMRI) in evaluating pulmonary hemodynamics and right ventricular function in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PAH); and the relationship between CMRI parameters and pulmonary function parameters, blood gas analysis parameters and 6-minute walk test (6MWT) parameters in patients with COPD complicated with PAH. Methods Thirty-seven patients were diagnosed with COPD in the department of respiratory and critical care discipline of Ningxia Medical University General Hospital from October 2013 to October 2016, who underwent transthoracic echocardiography (TTE) to measure pulmonary arterial systolic pressure (PASP), and were divided into COPD group and COPD+PAH group according to whether there was PAH [PASP > 40 mmHg (1 mmHg = 0.133 kPa) was defined as PAH]. All patients completed pulmonary function tests [1 second forced expiratory volume to forced vital capacity ratio (FEV1/FVC), FEV1 predicted value (FEV1pred)], blood gas analysis [arterial blood oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2)], CMRI examination [relative dilatation of the main pulmonary artery (mPAD), mean pulmonary artery pressure (mPAP), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), right ventricular end-diastolic myocardial mass (RVMED), right ventricular end-systolic myocardial mass (RVMES)], and 6MWD [6-minute walk distance (6MWD)] within 1 week. The obtained clinical parameters had been compared between the groups, and correlation was analyzed. Results Among the 37 patients with COPD, 16 patients were complicated with PAH. There were no significant differences in FEV1/FVC, FEV1pred, PaO2, PaCO2 and other baseline indicators between the two groups. In the COPD group, TTE obtained PASP of 2 patients were normal (PSAP < 40 mmHg), while CMRI measured mPAP were higher than the normal limit (> 25 mmHg). Compared with the COPD group, mPAD, RVEF and 6MWD were significantly decreased in the COPD+PAH group [mPAD: (25.64±5.01)% vs. (44.00±22.52)%, RVEF: 0.525±0.054 vs. 0.592±0.071, 6MWD (m): 319.3±116.5 vs. 408.2±38.0, all P < 0.01], mPAP, RVMED and RVMES were significantly increased [mPAP (mmHg): 28.89±3.16 vs. 20.18±2.43, RVMED (g): 57.19±15.46 vs. 40.71±15.44, RVMES (g): 45.99±11.16 vs. 33.71±13.39, all P < 0.01], and there was no significant differences in LVEF (0.663±0.082 vs. 0.699±0.075, P > 0.05). Correlation analysis showed that mPAD was positively correlated with FEV1/FVC and FEV1pred (r1 = 0.538, P1 = 0.021; r2 = 0.448, P2 = 0.049);RVMED was negatively correlated with PaO2 (r = -0.581, P = 0.015), and positively correlated with PaCO2 (r = 0.592, P = 0.014); 6MWD was positively correlated with RVEF (r = 0.485, P = 0.041), and had no correlation with LVEF (r = 0.271, P = 0.104). Conclusions Compared with COPD patients, changes in pulmonary hemodynamics and right ventricular function in COPD patients with PAH are related to the severity of airflow limitation. CMRI can early monitor pulmonary hemodynamics and right heart function changes in patients with COPD. Once PAH appears, pulmonary hemodynamics, right heart function and exercise tolerance have changed.

In the progress of the new healthcare reform, China has carried out a series of reform exploration in the drug distribution system.But fluctuating markups of drugs are still the main cause of high drug price.In order to simplify the distribution procedure, the National Health and Family Planning Commission proposed to encourage the implementation of two-receipt system nationwide.As the important part of the price system of drug circulation, drug distribution system made a great impact on the implementation of two-receipt system policy.Focusing on two provinces namely Fujian and Shaanxi provinces, this paper will discuss the typical drug distribution system in china.This paper has evaluated the main body and operation pattern in the implementation of two-receipt system, and by analyzing the benefits and drawbacks, in the same provinces.It has put forward the optimized distribution mode and provided policy suggestions for strengthening the two-receipt distribution system.

OBJECTIVETo investigate the antiatherogenic effect and possible mechanisms of the extracts of Radix Salviae Miltiorrhizae (RSM) or Fructus Crataegi (FC), as well as their interaction.

METHODWistar rats were randomly divided into 2 groups: normal group and model group. The atherosclerotic model rats were injected VD3 and ovalbumin, while fed with high cholesterol diet. After the model was determined successfully, all model rats were divided into normal group, model group, Xuezhikang group, RSM group, FC group, mixture of RSM and FC group. Each group was given the corresponding drugs for 4 weeks. After 12 weeks, blood serum were analyzed for total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C), superoxide dismutase ( SOD), malondialdehyde (MDA) and nitric oxide (NO). And the blood plasma also analyzed for levels of endothelin (ET), 6-keto prostaglandin F1alpha (6-keto-PGF1alpha), thromboxane B2 (TXB2), C-reactive protein (CRP), interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF-alpha) and so on. At last, the pathological observation of aorta was carried out.

RESULTCompared with those in model group, the TC, TG, LDL-C, ET, TXB2 and MDA levels and TXB2/PGF1alpha ratio were reduced, while the HDL-C, the serum SOD, No and 6-keto-PGF1alpha level were raised in the intervention groups. Although the levels of CRP, IL-6 and IL-8 were lower than model group, there was no obvious effect on the releasing of TNF-alpha.

CONCLUSIONRSM and FC could inhibit the atherogenesis formation and development, which might be due to regulating the lipid metabolism, enhancing the antioxidation, and reducing the release of inflammatory factors.

Animals ; Atherosclerosis ; prevention & control ; C-Reactive Protein ; analysis ; Crataegus ; Disease Models, Animal ; Interleukin-6 ; blood ; Lipid Peroxidation ; drug effects ; Lipids ; blood ; Male ; Plant Extracts ; therapeutic use ; Rats ; Rats, Wistar ; Salvia miltiorrhiza

Objective To investigate the effect of Intedeukin-18 (IL-18) on Th1/Th2 balance and its antitumor mechanism in C57BL/6 mice Lewis lung cancer model. Methods 24 C57BL/6 mice were randomly divided into three equal groups: group A(IL-18 injec-tion group, n = 8), group B (Lewis lung cancer model, n = 8) and group C (normal control group, n = 8). The Lewis lung cancer cells were cultured and implanted subcutaneously into the group A and group B. IL-18 and NS were given to group A and B respectively by intrap-eritoneal injection on the 7th day (once every day, 7 times altogether), but group C was not given any treatment. Enzyme-linked immunosor-bent assay (ELISA) was used to detect the Th1/Th2 cytokines. Health status in all the animals was evaluated; the volume and weight ofsubcutaneous tumors were measured. Results The concentration of IFN-γ in group A and C were significantly higher than those in group B (P <0.05), and the concentration of IL-4 in group A and C were significantly lower than those in group B (P<0.05), but there was no significant difference between group A and C (P>0.05). The tumor growth inhibitory rate was 75%. Conclusion IL-18 can effectively induced IFN-γ and inhibit IL-4 production, regulate Th1/Th2 balance in the C57BL/6 mice Lewis lung cancer model, and elicit the antitu-mor immunity of the host, which could obviously inhibit the growth of tumor cells and decelerate the proliferation of tumor cells.