Objective To investigate the clinical efficacy of Jiedu Huayu Granules(mainly composed of the Chinese herbal medicines of Artemisiae Scopariae Herba,Rhei Radix et Rhizoma,Hedyotis Diffusae Herba,Paeoniae Radix Rubra,Curcumae Radix and Acori Tatarinowii Rhizoma)in the treatment of liver failure(LF)and to observe their effects on endoplasmic reticulum stress and inflammatory response.Methods From May 2022 to May 2024,a total of 102 patients with LF of toxin-heat-stasis stagnation syndrome were collected from Hepatology Department of Yulin Traditional Chinese Medicine Hospital,and were divided into the control group and the study group by using a table of random numbers,with 51 cases in each group.The two groups were given comprehensive western medicine treatment for inhibiting inflammatory response and protecting liver,regulating intestinal microecology,counteracting viral infection,decreasing transaminase level and treating jaundice.Additionally,the study group was treated with Jiedu Huayu Granules.The course of treatment for the two groups covered eight weeks.Before and after treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,biochemical indicators,inflammatory factors and endoplasmic reticulum stress indicators.After treatment,the clinical efficacy and the incidence of adverse reactions of the two groups of patients were compared.Results(1)After eight weeks of treatment,the total effective rate of the study group was 86.27%(44/51)and that of the control group was 68.63%(35/51),and the intergroup comparison(tested by chi-square test)showed that the efficacy of the study group was significantly superior to that of the control group(P<0.05).(2)After treatment,the TCM syndrome scores in both groups were significantly decreased compared with those before treatment(P<0.01),and the decrease in the study group was significantly superior to that in the control group(P<0.05).(3)After treatment,the serum levels of biochemical indicators of total bilirubin(TBIL),total bile acid(TBA),alanine transaminase(ALT),and aspartate transaminase(AST)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the study group was significantly superior to that in the control group(P<0.05 or P<0.01).(4)After treatment,the serum levels of inflammatory factors of interleukin 6(IL-6),tumor necrosis factor α(TNF-α),transforming growth factor β(TGF-β),and C-reactive protein(CRP)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the study group was significantly superior to that in the control group(P<0.01).(5)After treatment,the levels of endoplasmic reticulum response indicators such as glucose-regulated protein 78(GRP78),CCAAT enhancer-binding protein homologous protein(CHOP),and cysteine aspartic acid specific protease 12(caspase-12)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the study group were significantly superior to those in the control group(P<0.01).(6)The incidence of adverse reactions in the study group was 15.69%(8/51)and that in the control group was 17.65%(9/51),and the comparison between the two groups showed that the difference was not statistically significant(P>0.05).Conclusion The combined use of Jiedu Huayu Granules with comprehensive western medicine treatment exerts certain efficacy in treating patients with LF of toxin-heat-stasis stagnation syndrome.The combined therapy is effective on relieving clinical symptoms and improving liver function,and is helpful for relieving endoplasmic reticulum stress and inflammatory response.

Objective To compare the clinical value of injury severity score (ISS) and CRAMS (circulation,respiration,abdomen,motor,speech) score in the prognosis of patients with severe multiple trauma in emergency department.Methods A total of 93 severe multiple trauma patients with 69 male and 24 female and age ranged from 21 to78 years with mean age (43.4 ± 14) years admitted in the emergency department from March 2014 to December 2015 were enrolled into this study.All of them were evaluated by using ISS and CRAMS score respectively and their survival during hospitalization was observed.Then,the predictive capabilities of ISS and CRAMS score for the mortality of patients were assessed by using receiver operator characteristic (ROC) curves.Results The mean ISS was (25.59 ± 5.37) and mean CRAMS score was (6.75 ± 1.26) in 93 patients with severe multiple trauma.Compared with the survival group (n =75),the ISS in the death group (n =18) was significantly higher (t =7.13,P ＜0.01) and CRAMS score was significantly lower (t =-6.03,P ＜0.01).In the ROC curve analysis,the AUCROC of predicting mortality of multiple trauma patients by ISS score was 0.897 and CRAMS score was 0.891,respectively.There was no significant difference in accuracy of predicting mortality between the two scoring systems (Z =0.718,P ＞ 0.05).When the death was chosen as the prediction target,the optimal cut-off point for ISS was 27 and CRAMS score was 6,respectively.Conclusions CRAMS score in comparison with ISS score has the likewise predictive value for the prognosis of severe multiple trauma patients in emergency department.However,the CRAMS score is simple and easy in practice.The changes of CRAMS score demonstrate the severity of trauma timely and reliably,which is in favor of the diagnosis and treatment of hospitalized trauma patients in early stage.