Objective To study the incidence,possible risk factors,and influence on patient outcomes of diaphragmatic dysfunction in patients after surgical treatment of type A aortic dissection using ultrasound.Methods Patients who received replacement of hemiarch or total arch with concomitant procedures concerning aortic pathology,and an elephant trunk procedure for the descending aorta were prospectively enrolled in this study from February to May 2017.After surgery,they were transferred to the cardiac surgical intensive care unit.They were divided into two groups based on diaphragmatic excursion:diaphragmatic dysfunction (DD) group and diaphragmatic function normal (DN) grouBilateral diaphragmatic excursions were evaluated using ultrasound during spontaneous breathing trial by T-tube.The differences in demographic characteristics,operation-related variables and outcomes were compared between the two groups.Results A total of 42 patients were enrolled in this study,and 32 of them suffered from diaphragmatic dysfunctions.Compared with DN group,the excursion of the influenced diaphragm in DD group was significantly reduced[(0.450 ± 0.331)cm vs.(1.801 ± 0.616)cm,P＜0.01],while the excursion of the non-influenced diaphragm was not reduced[(2.013±0.655)cm vs.(1.801 ±0.616) cm,P=0.254].Diaphragmatic thickness was comparable [(0.184±0.028)cm vs.(0.189±0.028)cm,P=0.559 ] between the two groups while thickening fraction was significantly reduced in DD group[(4.67％±3.63)％ vs.(23.58％±10.69)％,P＜0.01].Meanwhile,respiratory rate was significantly higher in DD group as compared to DN group [(24.13 ± 4.98)times/min vs.(20.50 ± 3.17)times/min,P=0.037].Patients in DD group showed longer cross-clamp duration[(121.78±27.75)min vs.(93.10±18.84)min,P=0.004] and longer cardiopulmonary bypass duration [(208.09±32.78)min vs.(182.70±24.38)min,P=0.03] than patients in DN grouFurthermore,binary logistic analysis indicated that longer cross-clamp duration was the potential risk factor for diaphragmatic dysfunction after type A aortic dissection surgery.Mechanical ventilation duration was longer in DD group than in DN group (88 h vs.37 h,P=0.194) but without statistical significance.The usage of noninvasive ventilation was significantly increased in DD group as compared to DN group (46.88％ vs.10％,P=0.036).Other outcomes such as post-operative complications,mortality,ICU length of stay were comparable between the two groups.Conclusions Diaphragmatic dysfunction was very common after surgical treatment of type A aortic dissection.Longer duration of cross-clamp was considered as a potential risk factor of diaphragmatic dysfunction.A sequential management of noninvasive ventilation after extubation was feasible for diaphragmatic dysfunction after surgical treatment of type A aortic dissection.

Objective To provide an index system and model for evaluating the development strategies of military preventive medicine (MPM).Methods SWOT was used to analyze the internal and external conditions of the development strategies of MPM,and the evaluation index system was constructed.The weight of each evaluation index was determined based on the analytic hierarchy process (AHP) and expert consultation.The evaluation model of MPM development strategies and confrontation matrix were constructed based on SWOT analysis.The effectiveness of the index system and model was evaluated through empirical research.Results The evaluation index system was constructed,which included four grade-one indexes (R&D quality,difficulty,requirement and support) and sixteen grade-two indexes (research level,academic status,etc.).The advantage and disadvantage models,opportunity threat model and SWOT evaluation model were established.The confrontation matrix of development strategies for MPM was developed.Conclusion This evaluation index system and model can accurately evaluate MPM development strategies and provide reference for formulating development strategies of MPM.

Objective To investigate the efficacy of dexmedetomidine on sedation in post-cardiac surgery patients with NIV intolerance.The changes of respiratory function and hemodynamics of the patients as well as non-invasive ventilation (NIV) failure rate were also under evaluation.Methods Thirty-five post-cardiac surgery patients with NIV intolerance and hypoxemia were enrolled in this prospective study.All patients were sedated with dexmedetomidine.NIV was standardized according to the uniform protocol.The main outcome was NIV success (avoiding endotracheal intubation) or NIV failure (requiring endotracheal intubation or die).The cardiorespiratory parameters (BP,HtR and RR) and artery blood gas analysis were prospectively recorded before and after sedation.The respiratory function and hemodynamics changes in both groups (NIV success group and NIV failure group) were then evaluated.Factors independently associated with NIV failure were identified using a logistic regression model.Results Twenty out of 35 patients (57.14％) survived while 15 (42.86％) patients failed NIV.After 1 h and 4 h of NIV with dexmedetomidine sedation,respiratory rate in both groups were decreased compared with baseline,especially in NIV success group.The PaO2/FiO2 was also improved after 1h and 4h of NIV treatment compared with baseline.The improvement was more significantly in NIV success group.The heart rate was decreased compared with baseline with no differences between two groups.There were no significant changes on PaCO2 and mean arterial pressure (MAP) during the treatment.The respiratory and hemodynamics variables identified as predictors of NIV failure were included in a multivariate logistic regression.RR ＞ 23 time/min (OR =3.2,95％ CI:2.043 ～ 4.301,P ＜ 0.01) 1 h after NIV,RR ＞ 20 time/min (OR =2.1,95％ CI:1.659～3.231,P=0.025) 4 h after NIV,PaO2/FiO2 ＜178 mmHg (OR=2.4,95％CI:1.892 ～ 3.287,P ＜0.01) 1 h after NIV and PaO2/FiO2 ＜ 185 mmHg (OR =1.7,95％ CI:1.243 ～ 2.365,P =0.041) 4 h after NIV independendy predicted NIV failure.Conclusions Dexmedetomidine might be considered as an effective and safe sedative for post-cardiac surgery patients with NIV intolerance.Early identification of predictors of NIV failure may facilitate early intervention.

Objective To investigate the effects of acupoint therapy on inflammatory factors and its clini-cal efficacy in relieving bronchial asthma. Methods Selected patients with bronchial asthma which was in remis-sion were randomly divided into a treatment group that was treated with acupoint therapy and a control group that was given Seretide. Each group had 30 cases. The treatment period was 4 weeks. Both groups were evaluated in terms of Asthma Control Test ( ACT) scores and the serum content of interleukin-5 ( IL-5) and interleukin-10 ( IL-10) before and at one month ( short-term) , as well as three months after the end of the treatment ( long-term) . The asthma control situation ( fully controlled, partially controlled or uncontrolled) was evaluated. Results Before treatment the average ACT scores of the two groups were not significantly different. After the treatment both the short-term and long-term average ACT scores of the treatment group were significantly higher than those of the con-trol group. The total effectiveness rate of asthma control in the treatment group in the short term ( 93%) was signifi-cantly higher than that in the control group ( 70%) . After the treatment the IL-5 and IL-10 levels in the treatment group were improved to a significantly greater extent than those in the control group. Conclusion Acupoint thera-py can reduce airway inflammation, control bronchial asthma symptoms and show good clinical efficacy, probably by regulating IL-5 and IL-10 levels.

OBJECTIVE: To evaluate the association between single nucleotide polymorphisms of calcium/calmodulin-dependent kinase 4 (CAMK4) and the therapeutic effect of amlodipine in essential hypertensive patients in Chinese Han nationality.
 METHODS: A total of 108 mild-to-moderate essential hypertension patients in Chinese Han nationality were treated with amlodipine for 8 weeks at a dosage of 5 mg/d. Polymerase chain reaction-restriction fragment length polymorphism was performed to detect the genotypes (rs10491334). Blood pressure was measured and analyzed.
 RESULTS: The result of rs10491334 polymorphism of CAMK4 was consistent with Hardy-Weinberg equilibrium distribution and the frequencies of C allele and T allele were 88.89% and 11.11%, respectively. The systolic blood pressure and diastolic blood pressure before amlodipine treatment were not statistically different among different genotype carriers (P>0.05). The blood pressure was significantly reduced in all patients after amlodipine treatment (P<0.05). Systolic blood pressure was significantly decreased in patients with rs10491334 CC genotype and CT genotype compared with those patients with rs10491334 TT genotype. Total effective rates of CT and TT carriers were higher than those of the CC genotype carriers (P<0.01).
 CONCLUSION The CAMK4 gene polymorphism might be associated with the efficacy of calcium channel blocker in treating mild-to-moderate essential hypertension patients.
Alleles ; Amlodipine ; Asian Continental Ancestry Group ; Blood Pressure ; Calcium-Calmodulin-Dependent Protein Kinase Type 4 ; Calmodulin ; Essential Hypertension ; Ethnic Groups ; Gene Frequency ; Genotype ; Humans ; Hypertension ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide

This study was aimed to evaluate the feasibility of wind-warm lung-heat disease (non-severe community-acquired pneumonia, CAP) from the clinical curative effect, hospitalization days, medical expenses and other aspects. This study selected 198 wind-warm lung-heat disease (non-severe CAP) inpatients from January, 2012 to December, 2012 with the conventional therapy in the Respiratory Department, Wuhan Integrated Traditional Chinese Medicine (TCM) & Western Medicine Hospital as the control group. And another 179 wind-warm lung-heat disease (non-severe CAP) inpatients were selected from January, 2013 to December, 2013 with the TCM clinical pathway treatment in the Respiratory Department of the same hospital as the treatment group. Retrospective analysis was used to compare the clinical curative effects, hospitalization days, and medical cost differences. The results showed that TCM clinical pathway for wind-warm lung-heat disease (non-severe CAP) can shorten the hospitalization days and reduce patients’ medical costs, and ensure the clinical curative effects. It was concluded that the standardized TCM clinical pathway had positive effect on wind-warm lung-heat disease (non-severe CAP). Therefore, the formulation and implementation of TCM clinical pathway was of great significance in the treatment of wind-warm lung-heat disease (non-severe CAP).

Objective To observe the therapeutic effect of traditional Chinese medicine(TCM)granules made by the formula of Shegan Mahuang decoction for treatment of patients with asthma. Methods A prospective study was conducted,51 cases of light to moderate asthma(cold type)patients were randomly divided into treatment group (25 cases)and control group(26 cases). Conventional symptomatic treatments were of the same in two groups. The patients in control group were given salbutamol aerosol inhalation,100μg each time,4 times per day;based on the treatment of the control group,additionally the above mentioned TCM granules dissolved in water was administered orally 1 dose/day taken twice once in the morning and another once in the evening in treatment group. The therapeutic course was 12 weeks in both groups. Before and after treatment,the asthma control test(ACT)score,forced expiratory volume in 1 second(FEV1)and peak expiratory flow(PEF)were observed. The therapeutic effect,adverse reaction and compliance were evaluated. Results The number of patients with asthma completely controlled in the treatment group was significantly higher than that in the control group(16 cases vs. 9 cases,χ2=4.82,P=0.028). In the patients of two groups,FEV1,PEF and ACT scores were significantly improved after treatment,and in the treatment group,they were obviously higher than those in control group〔FEV1(L):2.67±0.46 vs. 2.32±0.47,PEF(L/min):327.6±49.4 vs. 273.1±42.8,ACT score:22.8±2.0 vs. 21.1±2.6,all P<0.05〕. After treatment,FEV1%predicted value was increased in the treatment group but decreased in control group,there was significantly statistical difference〔(0.68±0.07)% vs.(0.80±0.11)%,P<0.05〕,no significant adverse reaction was found,compliance was good. Conclusion TCM granules made by formula of Shegan Mahuang decoction can improve the clinical symptoms, pulmonary function and control level in patients with asthma,so it is an effective medicine for the control of asthma.

Objective:To preliminarily study the effect of Louqin Zhisou decoctions with the mechanism of clearing heat and resol-ving phlegm on the blood level of neutrophil elastase ( NE) in the rat model of acute exacerbation of chronic obstructive pulmonary dis-ease ( AECOPD) . Methods:The rat model of AECOPD was established by passive cigarette smoking, intratracheal instillation of li-popolysacchricle ( LPY) and intranasal instillation of staphylococcus aureus. Totally 60 AECOPD rats were randomly divided into 3 groups, the model control group (n=20), ambrohexel group (n=20), and Louqin Zhisou decoctions group (n=20). NE was detec-ted by ELISA. Results:Compared with that before the treatment, NE in ambrohexel group and Louqin Zhisou decoctions group was de-creased significantly(P<0. 01). Conclusion:Clearing heat and resolving phlegm method probably can decrease NE by reducing air-way mucus hypersecretion and obstruction in AECOPD rats.

OBJECTIVETo observe the herbal effects on hyperthyroidism patients with syndrome of hyperactivity of liver-Yang by method for calming the liver and suppressing Yang and investigate its effects on the lymphocyte protein expression. This approach may lay a foundation for the further investigation of the curative mechanisms of calming the liver and suppressing Yang treatment.

METHODA total of 48 hyperthyroidism patients with syndrome of hyperactivity of liver-Yang were randomly divided into treatment group and control group. The treatment group was treated by method for calming the liver and suppressing Yang in accordance with traditional Chinese medicine (TCM) and the control group with thiamazole tablets for three periods of treatment The therapeutic effects, the score of TCM symptom, electrocardiogram (P wave), thyroid hormones and ultrasound were observed in both groups before and after the treatment. The side effects in the treatment course were observed in both groups. The level of differential protein expression was analyzed by two-dimensional electrphoresis and matrix assisted laser desorption/ionizaton time-of-flight mass spectrometry.

RESULTThe treatment group has the effect on stepping down the heart rate, cutting down the P wave amplitude changes, regulating the level of thyroid hormones and decreasing the volume of thyromegaly. There are not statistically significant between the treatment group and control group. However, the treatment group has obviously better effect on regulating TCM symptom and decreasing the side reaction than the control group (P<0.05). There are not statistically significant on the total effective between the treatment group and control group. The average spots in lymphocyte for normal people, before and after treating hyperthyroidism patients with syndrome of hyperactivity of liver-Yang were (429 +/- 31), (452 +/- 28) and (437 +/- 36) spots respectively. Eight down-regulated protein expressions and 11 up-regulated protein expressions were obtained in the hyperthyroidism patients with syndrome of hyperactivity of liver-Yang and normal people. Five strengthened expressions of protein were also obtained in 8 down-regulated expressions of protein and 8 lower expressions of protein in 11 up-regulated expressions of protein before and after treating the migraine patients with syndrome of hyperactivity of liver-Yang. Ten of the total 8 differential protein spots were successfully identified by MALDI-TOF-MS. The functions of these proteins were involved in metabolism associated, transportation, antioxidation, sigal transduction and immume associated protein, etc. according to information provided by NCBI and MSDB database.

CONCLUSIONIn this study, the TCM complex prescription with herbs for calming the liver and suppressing Yang can regulate the thyroid hormones, improves TCM symptoms, and decrease the adverse reaction. It can possibly regulate lymphocyte protein expression.

Adult ; Aged ; Databases, Protein ; Drugs, Chinese Herbal ; adverse effects ; pharmacology ; therapeutic use ; Electrocardiography ; Female ; Gene Expression Regulation ; drug effects ; Humans ; Hyperthyroidism ; drug therapy ; metabolism ; pathology ; physiopathology ; Liver ; drug effects ; pathology ; physiopathology ; Lymphocytes ; drug effects ; metabolism ; Male ; Middle Aged ; Proteins ; metabolism ; Thyroid Hormones ; metabolism ; Treatment Outcome ; Yin-Yang ; Young Adult

This study compared the efficacy and safety of tiotropium bromide inhalation powder (spiriva) and doxofylline oral tablet (doxofylline) in the treatment of chronic obstructive pulmonary disease (COPD). A multi-center, randomized, double-blind, double-dummy, parallel-controlled study involved 127 eligible stable moderate to severe COPD patients treated with inhaled tiotropium dry powder (18 μg/day) or oral doxofylline tablets (0.2 g/time, 2 times a day) for 12 and 24 weeks. Before and after treatment for 12 weeks and 24 weeks, respectively, pulmonary function, 6-min walking distance and dyspnea index were recorded. The results showed that in both tiotropium group and doxofylline groups, after 12-week treatment, FEV(1), FEV(1)/FVC% and 6-min walk distance were significantly higher than those before the medication, while dyspnea index decreased as compared with that before treatment. After 24-week treatment, a slight improvement in the measures was observed as compared with that of 12-weeks treatment, but the difference was not statistically significant. With both 12-week and 24-week treatment, the effect of tiotropium was slightly better than that of doxofylline tablets, with the difference being statistically insignificant. The major adverse events in the tiotropium group and doxofylline group were observed in 9 cases (9.9%) and 12 cases (12.9%), respectively, and no statistically significant difference was found between them. We are led to conclude that both tiotropium at 18 μg a day and doxofylline tablets at 0.2 g/day (two times a day) are effective and safe for the treatment of COPD.