[Objective]Based on the ancient view of"four seasons and five elements",to analyze the source of the two contradictory texts in Inner Canon of Huangdi,namely,the spleen is not in control and the flat pulse is not in control("the good one is not visible"),and the spleen is in control of the long summer and the flat pulse is in control("the soft one is weak"or"apart from the soft one,like a chicken treading on the ground").[Methods]By adopting an integrated research approach that combines philology,historiography and theoretical studies,this paper first interprets the relevant theories of the seasonal-visceral pulses in Inner Canon of Huangdi and points out the textual contradictions existing therein.Then,it traces the origin of the Five Elements thought in the formation of the seasonal-visceral pulse theory,revealing the two main schemas generated by the Five Elements doctrine in different stages of development.Finally,from the perspective of how philosophical thoughts influence the formation of medical theories,it explains the construction of the seasonal-visceral theory in Inner Canon of Huangdi.Furthermore,using the dual-evidence method and combining the unearthed literature Tianhui Medical Bamboo Slips,it points out the reasons for the emergence of the seasonal-visceral pulse texts and further conducts an objective reflection on the methods of interpreting medical classics.[Results]The emergence of the text contradiction of the viscera was closely related to the view of"four seasons and five elements"and the"five seasons and five elements"produced by its evolution.The concept of"four seasons and five elements"originated from the ancient people's simple observation and understanding of the composition and interrelationship of time and space and the material world,and was based on nature and social practice.The concept of"four seasons and five elements"is used in the construction of the theory of four seasons and five viscera in traditional Chinese medicine.Under the theory system of four seasons and five viscera,the spleen was the main palace,not the main time,so the spleen did not respond to the normal pulse.The"five seasons and five elements"was accompanied by the emergence of the five elements of the circulation pattern,the reinterpretation of the law of the four seasons,the five seasons should be a more complete closed loop of the five viscera,but it was not derived from a more universal practice law,and can not completely replace the theory of the viscera under the guidance of the four seasons and five elements.In particular,the flat pulse of the spleen governing the summer in the five viscera veins did not have clinical reference,but to a greater extent,it was a mechanical adaptation for the logical self-consistency of the five seasons thought.[Conclusion]The philosophical thought of the Five Elements is the root cause of the textual contradictions in the seasonal-visceral pulse theory,which reflects that the construction of TCM theory is deeply influenced by ancient Chinese philosophy.Abiding by the laws of objective practice and clarifying the formation and evolution of medical-philosophical thoughts are conducive to a deeper understanding of Inner Canon of Huangdi,thereby better interpreting and inheriting the classics.

[Objective]Based on the ancient view of"four seasons and five elements",to analyze the source of the two contradictory texts in Inner Canon of Huangdi,namely,the spleen is not in control and the flat pulse is not in control("the good one is not visible"),and the spleen is in control of the long summer and the flat pulse is in control("the soft one is weak"or"apart from the soft one,like a chicken treading on the ground").[Methods]By adopting an integrated research approach that combines philology,historiography and theoretical studies,this paper first interprets the relevant theories of the seasonal-visceral pulses in Inner Canon of Huangdi and points out the textual contradictions existing therein.Then,it traces the origin of the Five Elements thought in the formation of the seasonal-visceral pulse theory,revealing the two main schemas generated by the Five Elements doctrine in different stages of development.Finally,from the perspective of how philosophical thoughts influence the formation of medical theories,it explains the construction of the seasonal-visceral theory in Inner Canon of Huangdi.Furthermore,using the dual-evidence method and combining the unearthed literature Tianhui Medical Bamboo Slips,it points out the reasons for the emergence of the seasonal-visceral pulse texts and further conducts an objective reflection on the methods of interpreting medical classics.[Results]The emergence of the text contradiction of the viscera was closely related to the view of"four seasons and five elements"and the"five seasons and five elements"produced by its evolution.The concept of"four seasons and five elements"originated from the ancient people's simple observation and understanding of the composition and interrelationship of time and space and the material world,and was based on nature and social practice.The concept of"four seasons and five elements"is used in the construction of the theory of four seasons and five viscera in traditional Chinese medicine.Under the theory system of four seasons and five viscera,the spleen was the main palace,not the main time,so the spleen did not respond to the normal pulse.The"five seasons and five elements"was accompanied by the emergence of the five elements of the circulation pattern,the reinterpretation of the law of the four seasons,the five seasons should be a more complete closed loop of the five viscera,but it was not derived from a more universal practice law,and can not completely replace the theory of the viscera under the guidance of the four seasons and five elements.In particular,the flat pulse of the spleen governing the summer in the five viscera veins did not have clinical reference,but to a greater extent,it was a mechanical adaptation for the logical self-consistency of the five seasons thought.[Conclusion]The philosophical thought of the Five Elements is the root cause of the textual contradictions in the seasonal-visceral pulse theory,which reflects that the construction of TCM theory is deeply influenced by ancient Chinese philosophy.Abiding by the laws of objective practice and clarifying the formation and evolution of medical-philosophical thoughts are conducive to a deeper understanding of Inner Canon of Huangdi,thereby better interpreting and inheriting the classics.

Background The pathogenesis of beryllium-induced pulmonary fibrosis is unknown and there is no specific treatment for the disease as yet. MicroRNA (miRNA) may play a role in the process of beryllium-induced pulmonary fibrosis. Objective To construct a microRNA-21 (miR-21) interfering cell line, and to investigate the effect of miR-21 on beryllium sulfate (BeSO₄)-induced fibrosis in human lung adenocarcinoma alveolar basal epithelial cells (A549 cells) and its potential mechanism. Methods The miR-21 target genes were predicted by the online database miRBase and verified by experiments using dual luciferase reporter gene. After transfecting A549 with miR-21interference lentivirus, puromycin was used to select a stable cell line. An in vitro model of pulmonary fibrosis was established using BeSO₄ infecting A549 cells with a concentration of 10 μmol·L⁻¹ and an exposure time of 48 h. Then the treated cells were divided into control group, model group, miR-21 interference group, and miR-21 interference control group. Real-time fluorescent quantitative PCR (RT-qPCR) was used to detect the relative expression level of miR-21 gene. Western blotting was used to detect the relative expression levels of TGF-β1/Smads pathway related proteins [Smad2, Smad3, p-Smad2, p-Smad3, Smad7, and transforming growth factor-β1 (TGF-β1)], myofibrosis cell marker α-smooth muscle actin (α-SMA), andextracellular matrix collagen-I (COL-I) and collagen-Ⅲ (COL-Ⅲ). Results The miRBase predicted that miR-21 had a binding site with Smad7, and the results of the dual luciferase reporter gene experiment showed that the target gene of miR-21 was Smad7. The construction of miR-21 interfered with A549 cell line was successful. Compared with the control group, the relative expression of miR-21 gene in the model group increased by 97.57%; the relative expression of Smad7 protein in the model group decreased by 15.48%; the relative protein expression of Smad2, Smad3, p-Smad2, p-Smad3, TGF-β1, α-SMA, COL-I, and COL-Ⅲ increased by 13.55%, 35.72%, 18.35%, 35.75%, 25.52%, 31.58%, 24.61%, and 11.66% respectively (P<0.05). Compared with the interference control group, the miR-21 gene expression level in the interference group decreased by 28.96%; the relative expression of Smad7 protein increased by 19.07%; the relative protein expression of Smad2, Smad3, p-Smad2, p-Smad3, TGF-β1, α-SMA, COL-I, and COL-Ⅲ decreased by 8.01%, 19.95%, 14.56%, 19.37%, 11.95%, 10.96%, 18.81%, and 31.36% repectively (P<0.05). There was no statistically significant difference in the gene abd protein expression levels of each gene between the model group and the interference control group (P>0.05). Conclusion In an in vitro model of pulmonary fibrosis induced by beryllium compounds, miR-21 may promote fibrosis by targeting Smad7 to regulate the TGF-β1/Smad signaling pathway.

Objective:To investigate the effect of chronic stress of pregnant rats on the gut microbiota of female rats and offspring, and explore the role of intestinal microbiota in chronic stress during pregnancy.Methods:In November 2019, SPF-grade healthy adult SD rats were selected. 16 female rats were randomly divided into control group and model group, with 8 in each group; 12 male rats were randomly divided into model mating group (8) and control mating group (4) . A model of chronic unpredictable mild stress (CUMS) during pregnancy was established. Blood samples were collected from the iliac vein of the female rats 1 day before and 1, 7, and 14 days after the CUMS protocol, and measured for plasma corticosterone content by radioimmunoassay. After the stress was completed, fresh feces of the female rats were collected for testing. The offspring's fresh stool samples were collected on postnatal day 20 (PND20) , and they were divided into control offspring group and model offspring group samples. The sequence of 16S rRNAV3-V4 regions of microorganisms in the feces of offspring was determined by Illumina MiSeq technique; and the interaction between microbial community structure and diversity were analyzed.Results:The content of plasma corticosterone in the model group was higher than that in the control group on the 7th and 14th day of stress ( P<0.05) . Compared with the control group, the Sobs index, Chao index, ACE index and Shannon index of the model group were decreased ( P<0.05) . The number of unique species abundance (OTU) in the control group was 130, and 91 in the model group. The relative abundance of female Firmicutes in the control group (64.87%) was higher than that in the model group, and the relative abundance of Bacteroides (31.72%) was lower than that of the model group (46.35%) . The Sobs index, Chao index, ACE index, Simpson index and Shannon index of the control offspring group were higher than those of the model offspring group ( P<0.05) . The number of unique OTUs in the model offspring group was 75, and 93 in the control offspring group. The relative abundance of Firmicutes (60.24%) in the control offspring group was higher than that of the model offspring group (52.95%) . Conclusion:Chronic stress during pregnancy can not only lead to the disorder of intestinal flora in female rats, but also lead to the change of intrauterine environment, thus affecting the diversity of intestinal flora in offspring.

Objective:To investigate the effect of chronic stress of pregnant rats on the gut microbiota of female rats and offspring, and explore the role of intestinal microbiota in chronic stress during pregnancy.Methods:In November 2019, SPF-grade healthy adult SD rats were selected. 16 female rats were randomly divided into control group and model group, with 8 in each group; 12 male rats were randomly divided into model mating group (8) and control mating group (4) . A model of chronic unpredictable mild stress (CUMS) during pregnancy was established. Blood samples were collected from the iliac vein of the female rats 1 day before and 1, 7, and 14 days after the CUMS protocol, and measured for plasma corticosterone content by radioimmunoassay. After the stress was completed, fresh feces of the female rats were collected for testing. The offspring's fresh stool samples were collected on postnatal day 20 (PND20) , and they were divided into control offspring group and model offspring group samples. The sequence of 16S rRNAV3-V4 regions of microorganisms in the feces of offspring was determined by Illumina MiSeq technique; and the interaction between microbial community structure and diversity were analyzed.Results:The content of plasma corticosterone in the model group was higher than that in the control group on the 7th and 14th day of stress ( P<0.05) . Compared with the control group, the Sobs index, Chao index, ACE index and Shannon index of the model group were decreased ( P<0.05) . The number of unique species abundance (OTU) in the control group was 130, and 91 in the model group. The relative abundance of female Firmicutes in the control group (64.87%) was higher than that in the model group, and the relative abundance of Bacteroides (31.72%) was lower than that of the model group (46.35%) . The Sobs index, Chao index, ACE index, Simpson index and Shannon index of the control offspring group were higher than those of the model offspring group ( P<0.05) . The number of unique OTUs in the model offspring group was 75, and 93 in the control offspring group. The relative abundance of Firmicutes (60.24%) in the control offspring group was higher than that of the model offspring group (52.95%) . Conclusion:Chronic stress during pregnancy can not only lead to the disorder of intestinal flora in female rats, but also lead to the change of intrauterine environment, thus affecting the diversity of intestinal flora in offspring.

Objective To investigate whether the change of cardiac output (CO) with bed head raising (BHR) combined with passive leg raising (PLR) can be used to assess volume overload in critical patients.Methods A prospective observational diagnostic trial was designed. The patients who underwent fluid resuscitation 6 hours or more, and admitted to intensive care unit (ICU) of Meizhou People's Hospital in Guangdong Province from January to December in 2016 were enrolled. Volume overload were identified with the criteria including the increasing of pulmonary rales, the higher levels of N-terminal brain natriuretic peptide (NT-proBNP) and new pulmonary exudates in chest radiograph. CO and heart rate (HR) were monitored with impedance cardiography at supine position and BHR by 30°(BHR30), 60° (BHR60), and PLR in all patients. The changes of CO (?CO30,?CO60,?COPLR) and HR (?HR30,?HR60,?HRPLR) were calculated at different positions. The receiver operating characteristic curve (ROC) was used to evaluate the predictive values of?CO30,?CO60 and combination of?CO60 and?COPLR on volume overload.Results A total of 62 patients were enrolled in this study, with 44 males and 18 females, age of (58.9±15.9) years, a body mass index of (22.7±2.4) kg/m2, and an acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of 18.7±4.4. The CO of 32 patients with volume overload was significantly increased at BHR30 or BHR60 compared with supine position [?CO30 was (14.5±11.5)%,?CO60 was (26.9±17.5)%, bothP< 0.01], and the?CO60 was increased more than the?CO30 (P < 0.01);while CO was slightly decreased after PLR,?COPLR was (-8.4±11.3)% (P > 0.05). There was no consistent change of CO at BHR30 or BHR60 compared with supine position in 30 patients without volume overload,?CO30 was (-3.4±9.1)% (P < 0.05),?CO60 was (-2.4±14.0)% (P > 0.05), while CO was significantly increased after PLR,?COPLR was (12.4±11.3)% (P < 0.01). There was no significant change of HR after BHR and PLR in patients with volume overload and non volume overload. ROC curve showed that when the cut-off value of ΔCO30≥3.3%, the area under ROC curve (AUC) was 0.903±0.039, the sensitivity was 90.6%, the specificity was 80.0%, and the accuracy was 85.5% for predicting volume overload; when the cut-off value of ΔCO60≥5.6%, the AUC was 0.911±0.036, the sensitivity was 96.9%, the specificity was 73.3%, and the accuracy was 85.5% for predicting volume overload. If volume overload was assessed by the increase of ΔCO60 combining with the decrease of ΔCOPLR, the AUC was 0.928±0.034, the optimal cut-off value for the new combined predictive indicator in predicting volume overload was -0.008, and the sensitivity, specificity, accuracy was 96.9%, 83.3%, 90.3%, respectively, and its evaluation effect is better than the use of ΔCO30 or ΔCO60 alone.Conclusion The change of CO with BHR combined with PLR can be used to accurately evaluate volume overload in patient with critically illness.

Objective To investigate the sleep quality state of people who did physical examination,and its correlation with brachial-ankle Pulse Wave Velocity (baPWV).Methods The indexes of Pittsburgh sleep quality index (PSQI) and baPWV were used.The people who did physical examination were divided into sleep disorders group (284 cases) and normal sleep group (608 cases) according to the results of PSQI survey.Results (1) There were 31.84％ of the people who had sleep quality problems.(2) The PSQI total score and the score of subjective sleep quality (SSQ),sleep duration (Sdu),daytime dysfunction (DD) of females were higher than males (t =6.71,3.46,2.45,3.96,P ＜0.05).The PSQI total score and the score of sleep latency (SL),habitual sleep efficiency (HSE),use of sleeping medication (USM) among different age groups were statistically analyzed (F =12.23,8.31,7.50,7.11,P ＜ 0.05).(3) The score of baPWV of sleep disorders group was higher than normal sleep group (t =5.14,P ＜ 0.05).There were significantly positive correlation between baPWV and total PSQI score,subjective sleep quality,sleep time,daytime dysfunction (r =0.28,0.45,0.30,0.36,0.35,P ＜ 0.05).Conclusions 1/3 of the physical examination people have sleep quality problems.Sleep quality of females is worse than males.There are different styles among different age groups.There is significantly positive correlation between sleep quality and baPWV.

Objective To explore the role of procalcitonin(PCT)in antibiotics therapy of elder patients with community acquired pneumonia(CAP). Methods Sixty-two elderly patients with CAP who hospitalized in Linxi Hospital of Kailuan General Hospital from Jan. 2010 to Dec. 2013 were selected as study subjects,and their age span were 54. 0 - 87. 0 years old. All the patients were randomly divided into conventional therapy group(n= 33)and PCT group(n = 29). The use of nntibiotics in conventional treatment group was based on clinical symptoms of patients and the standard of antibiotics application in clinic,while in PCT group was based on PCT serum levels. The main observation indexes including days of antibiotics use,cost of antibiotics use,hospital stay, total cost of hospital stay,clinical efficacy,aggravating cases and death cases. Results The days of antibiotics use,cost of antibiotics use,hospital stay,total cost of hospital stay in PCT group were((12. 2 ± 1. 4)d, (3 341. 9 ± 52. 73)yuan,(12. 1 ± 1. 8)d,(5 346. 2 ± 1 274. 5)yuan)lower than that in conventional therapy group((16. 9 ± 3. 5)d,(3 816. 28 ± 84. 27)yuan,(14. 7 ± 2. 9)d,(6 653. 2 ± 1 132. 8)yuan),and the differences were significant(t = 6. 77,26. 14,4. 17,4. 28;P < 0. 001). There were no significant difference in terms of clinical prognosis( clinical efficacy,aggravating cases and death cases)( P > 0. 05). Conclusion Procalcitonin can guide antibiotics application in the elderly patients,and then prevent the abuse of antibiotics.

This article summarized TCM education development history of Sino-US,with emphasis on Sino-US TCM education development of horizontal comparison in terms of admission requirements,faculty,teaching materials,forms of education,a comprehensive understanding of the characteristics and differences of the two countries education which beneficial to both countries education to learn from each other.

Objective To discuss perioperative nursing of pediatric patients with tethered spinal cord syndrome (TCS). Methods 35 pediatric patients with TCS underwent surgical treatment. Pre-operative nursing included psychological care for the parents to eliminate their fear and worries, prona-tion position practice and clean of skin for the children patients, post- operative care included monitor-ing of vital signs, maintaining of proper positions,close observation of the wound, skin care and rehabili-tation training. Results After intensive care, all cases went through the perioperstive period without bed sores. During follow- up disappearance of clinical symptoms occurred in 24 cases, 3 cases got allevia-tion,7 cases with no improvement, and 1 case with deteriorated clinical symptom. Conclusions Preopera-tive care for patients with tethered cord syndrome can provide doctors with the diagnosis and treatment reference, and it plays an important role in treatment and rehabilitation of children patients.