In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

To investigate the therapeutic effect of open reduction and internal fixation (ORIF) on supination external rotation (SER) ankle fractures (AF) and its impact on ankle joint function and range of motion in patients.Methods:The observation group patients were treated with ORIF, while the control group patients were treated with manual reduction combined with plaster external fixation. Both groups of patients were followed up after 3 and 6 months of treatment. Compare the ankle joint function levels of two groups of patients before treatment and after 3 and 6 months of treatment (Kofood score, AOFAS score, Olerud Molander subjective ankle score (OMAS)). Compare the joint range of motion (relative peak force, torque acceleration energy, endurance) between two groups of patients after 3 and 6 months of treatment. Compare the clinical indicators and incidence of adverse events between two groups of patients after 6 months of treatment. T-test was used for comparison between two groups. Multiple group comparisons were conducted using analysis of variance, while pairwise comparisons were conducted using Dunnett-t test. Comparison of count data between groups using χ2 inspections or Fisher exact test. Results:Before treatment, there was no statistically significant difference in the Kofoed score, AOFAS score, and OMAS score between the two groups of patients (all P>0.05). The Kofoed scores of patients in the observation group before treatment and at 3 and 6 months of treatment were (53.78±6.40), (76.73±4.12), and (89.07±5.78) points, respectively. The control group was (52.22±7.08), (71.68±4.82), and (84.05±5.45) points, respectively. The Kofoed scores of patients in both groups were higher than before treatment at 3 and 6 months of treatment (all P<0.05), and the observation group was higher than the control group (all P<0.01).The AOFAS scores of patients in the observation group before treatment and at 3 and 6 months of treatment were (70.13±5.39), (81.62±4.25), and (92.05±4.15) points, respectively. The control group was (69.85±5.41), (79.08±4.60), and (88.92±4.43) points, respectively. The AOFAS scores of patients in both groups were higher than before treatment at 3 and 6 months of treatment (all P<0.05), and the observation group was significantly higher than the control group (all P<0.01).The OMAS scores of the observation group patients before treatment and at 3 and 6 months of treatment were (53.43±5.07), (76.14±4.52), and (85.68±4.14) points, respectively. The control group was (54.42±4.86), (71.39±3.94), and (81.78±4.15) points, respectively. The OMAS scores of the two groups of patients at 3 and 6 months of treatment were higher than before treatment (all P<0.05), and the observation group was higher than the control group (all P<0.01). The fracture healing time (38.85±4.50) days and complete weight-bearing time (66.62±7.14) days of the observation group patients were shorter than those of the control group patients (49.42±5.43) days and (74.39±6.75) days, and the differences between the two groups were statistically significant (t-values were 12.89 and 6.80, respectively, all P<0.01); There was no statistically significant difference in the incidence of adverse events between the two groups of patients (5.41% (4/74) and 9.46% (7/74)), χ2=0.88, P=0.347). Conclusion:ORIF has a good therapeutic effect on SER-AF patients, promotes ankle joint function recovery, and has a low incidence of adverse events, indicating good safety.

Objective To analyze the medication law of core prescriptions and categorized prescriptions of TCM for the treatment of heart failure with preserved ejection fraction(HFpEF);To provide references for clinical prescriptions of HFpEF.Methods The clinical research literature on TCM for HFpEF was retrieved from CNKI,Wanfang Data,VIP,CBM,PubMed,Web of Science,Embase and Cochrane Library from establishment of the databases to November 1,2023.Data mining methods,such as complex network,prescription similarity network and community detection method were used to explore the prescription medication law of HFpEF.Results Totally 142 articles related to TCM treatment of HFpEF were included,containing 146 prescriptions and involving 162 kinds of Chinese materia medica.The most frequently used drugs were represented by Astragali Radix,Salviae Miltiorrhizae Radix et Rhizoma and Poria.The core prescription and the commonly used modified law of HFpEF treatment were obtained by complex network analysis.The core prescription consisted of Astragali Radix,Poria,Salviae Miltiorrhizae Radix et Rhizoma,Glycyrrhizae Radix et Rhizoma,Chuanxiong Rhizoma,Cinnamomi Ramulus,Descurainiae Semen Lepidii Semen,Atractylodis Macrocephalae Rhizoma,Paeoniae Radix Rubra,Ophiopogonis Radix and Angelicae Sinensis Radix.Further based on the prescription similarity network and community detection method,the basic prescriptions of the 3 major community of categorized prescription corresponding to the HFpEF staging and syndrome types were obtained,and the staged diagnosis and treatment medication law with the development of the HFpEF disease course were found.Conclusion Invigorating qi and activating blood circulation,warming yang and promoting diuresis are the main therapeutic principles of HFpEF.Data mining technology provides a feasible method for the analysis of core prescriptions and categorized prescriptions for HFpEF,which can provide a basis for the diagnosis and treatment law and medication experience of HFpEF in TCM.

Objective:To understand the current situation of syphilis infection among 12 295 blood donors in Huainan area, so as to provide reference for the management of public health.Methods:The Treponema pallidum(TP) antibody of the blood donors was screened by enzyme-linked immunosorbent assay, and the unqualified blood donors for TP antibody were confirmed by Treponema pallidum particle agglutination(TPPA).Results:There were 48 blood donors TPPA positive among 12 295 blood donors in Huainan area, and the TPPA positive rate was 3.90‰(48/12 295). There was no statistically significant difference in the TPPA positive rate of the different gender blood donors[male 3.12‰(22/7 048) vs.female 4.96‰(26/5 247)] in Huainan area( u=1.61, P>0.05). There was statistically significant difference in the TPPA positive rate of the different marriage blood donors[married 5.33‰(42/7 884) vs.unmarried 2.01‰(6/2 989)] in Huainan area( u=2.33, P<0.05). There was statistically significant difference in the TPPA positive rate of the blood donors among different education level in Huainan area(χ 2=29.94, P<0.05). There was no statistically significant difference in the TPPA positive rate of the blood donors among ABO blood groups in Huainan area(χ 2=2.24, P>0.05). Conclusion:There are significant differences in the TPPA positive rates of the blood donors among marital status and education level in Huainan area.

Pediatric cough is a heterogeneous condition in terms of symptoms and the underlying disease mechanisms. Symptom phenotypes hold complicated interactions between each other to form an intricate network structure. This study aims to investigate whether the network structure of pediatric cough symptoms is associated with the prognosis and outcome of patients. A total of 384 cases were derived from the electronic medical records of a highly experienced traditional Chinese medicine (TCM) physician. The data were divided into two groups according to the therapeutic effect, namely, an invalid group (group A with 40 cases of poor efficacy) and a valid group (group B with 344 cases of good efficacy). Several well-established analysis methods, namely, statistical test, correlation analysis, and complex network analysis, were used to analyze the data. This study reports that symptom networks of patients with pediatric cough are related to the effectiveness of treatment: a dense network of symptoms is associated with great difficulty in treatment. Interventions with the most different symptoms in the symptom network may have improved therapeutic effects.

Coronavirus disease 2019 (COVID-19) is now pandemic worldwide and has heavily overloaded hospitals in Wuhan City, China during the time between late January and February. We reported the clinical features and therapeutic characteristics of moderate COVID-19 cases in Wuhan that were treated via the integration of traditional Chinese medicine (TCM) and Western medicine. We collected electronic medical record (EMR) data, which included the full clinical profiles of patients, from a designated TCM hospital in Wuhan. The structured data of symptoms and drugs from admission notes were obtained through an information extraction process. Other key clinical entities were also confirmed and normalized to obtain information on the diagnosis, clinical treatments, laboratory tests, and outcomes of the patients. A total of 293 COVID-19 inpatient cases, including 207 moderate and 86 (29.3%) severe cases, were included in our research. Among these cases, 238 were discharged, 31 were transferred, and 24 (all severe cases) died in the hospital. Our COVID-19 cases involved elderly patients with advanced ages (57 years on average) and high comorbidity rates (61%). Our results reconfirmed several well-recognized risk factors, such as age, gender (male), and comorbidities, as well as provided novel laboratory indications (e.g., cholesterol) and TCM-specific phenotype markers (e.g., dull tongue) that were relevant to COVID-19 infections and prognosis. In addition to antiviral/antibiotics and standard supportive therapies, TCM herbal prescriptions incorporating 290 distinct herbs were used in 273 (93%) cases. The cases that received TCM treatment had lower death rates than those that did not receive TCM treatment (17/273 = 6.2% vs. 7/20= 35%, P = 0.0004 for all cases; 17/77= 22% vs. 7/9= 77.7%, P = 0.002 for severe cases). The TCM herbal prescriptions used for the treatment of COVID-19 infections mainly consisted of Pericarpium Citri Reticulatae, Radix Scutellariae, Rhizoma Pinellia, and their combinations, which reflected the practical TCM principles (e.g., clearing heat and dampening phlegm). Lastly, 59% of the patients received treatment, including antiviral, antibiotics, and Chinese patent medicine, before admission. This situation might have some effects on symptoms, such as fever and dry cough. By using EMR data, we described the clinical features and therapeutic characteristics of 293 COVID-19 cases treated via the integration of TCM herbal prescriptions and Western medicine. Clinical manifestations and treatments before admission and in the hospital were investigated. Our results preliminarily showed the potential effectiveness of TCM herbal prescriptions and their regularities in COVID-19 treatment.
Adult ; Aged ; Aged, 80 and over ; COVID-19/therapy* ; China ; Combined Modality Therapy ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Hospitalization ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Retrospective Studies ; Survival Rate ; Treatment Outcome

Objective To assess and compare the incidence,clinical characteristics,treatment,and prognosis of acute heart failure patients from different grades hospitals in Beijing.Methods In this prospective internet prognosis registered study (Beijing AHF Registry),a total of 3 335 consecutive patients admitted to 14 emergency departments in Beijing from January 1st 2011 to September 23rd 2012 were enrolled.According to hospital grade,these patients were divided into two groups,349 patients were from secondary hospitals,and 2 956 patients were from tertiary hospitals.Results Among the 3 335 patients,the medium age was 71 (58,79) years,and male accounted for 53.16％.The most common underlying disease were coronary disease (43.27％),hypertension (17.73％),cardiomyopathy (16.07％) etc.The average treatment time in Emergency Department was 66.82 h.The emergency department mortality rate was 3.81％ (127 cases).The 30-day and 1-year cumulative all-cause mortality were 15.3％ and 32.27％,respectively.The 30-day and 1-year cumulative all-cause readmission were 15.64％ and 46.89％,respectively.Compared with patients in tertiary hospitals,patients in secondary hospitals had more onset acute heart failure patients (63.64％ vs.49.93％),shorter emergency department treatment time (12 h vs.41 h),lower discharge rate (3.43％ vs.37.45％) and emergency department mortality(1.58％ vs.4.09％).Compared with those in tertiary hospitals,1-year cumulative all-cause mortality (25.6％ vs.33.2％),cardiovascular disease mortality (20.2％ vs.26.0％),aggravated heart failure mortality (22.4％ vs.28.8％) were lower in secondary hospitals.Following propensity score matching,compared to tertiary hospitals,patients in secondary hospitals showed lower utilization rate of beta-blockers and ACEFARB (4.51％ vs.28.17％,1.41％ vs.9.58％),except the pironolactone.Conclusion Acute heart failure in emergency department is associated with a high mortality rate and readmission rate.There is still a big gap between guidelines recommend medication current treatments for acute heart failure.

Acute ischemic stroke (AIS), as the third leading cause of death worldwide, is characterized by its high incidence, mortality rate, high incurred disability rate, and frequent reoccurrence. The neuroprotective effects of Ginkgo biloba extract (GBE) against several cerebral diseases have been reported in previous studies, but the underlying mechanisms of action are still unclear. Using a novel in vitro rat cortical capillary endothelial cell-astrocyte-neuron network model, we investigated the neuroprotective effects of GBE and one of its important constituents, Ginkgolide B (GB), against oxygen-glucose deprivation/reoxygenation and glucose (OGD/R) injury. In this model, rat cortical capillary endothelial cells, astrocytes, and neurons were cocultured so that they could be synchronously observed in the same system. Pretreatment with GBE or GB increased the neuron cell viability, ameliorated cell injury, and inhibited the cell apoptotic rate through Bax and Bcl-2 expression regulation after OGD/R injury. Furthermore, GBE or GB pretreatment enhanced the transendothelial electrical resistance of capillary endothelial monolayers, reduced the endothelial permeability coefficients for sodium fluorescein (Na-F), and increased the expression levels of tight junction proteins, namely, ZO-1 and occludin, in endothelial cells. Results demonstrated the preventive effects of GBE on neuronal cell death and enhancement of the function of brain capillary endothelial monolayers after OGD/R injury in vitro; thus, GBE could be used as an effective neuroprotective agent for AIS/reperfusion, with GB as one of its significant constituents.
Animals ; Apoptosis ; drug effects ; Brain Ischemia ; drug therapy ; Cell Survival ; Cells, Cultured ; Disease Models, Animal ; Endothelial Cells ; drug effects ; Ginkgolides ; pharmacology ; Glucose ; Lactones ; pharmacology ; Neurons ; drug effects ; Neuroprotective Agents ; pharmacology ; Oxygen ; Plant Extracts ; pharmacology ; Rats ; Stroke ; drug therapy

Determining effective traditional Chinese medicine (TCM) treatments for specific disease conditions or particular patient groups is a difficult issue that necessitates investigation because of the complicated personalized manifestations in real-world patients and the individualized combination therapies prescribed in clinical settings. In this study, a multistage analysis method that integrates propensity case matching, complex network analysis, and herb set enrichment analysis was proposed to identify effective herb prescriptions for particular diseases (e.g., insomnia). First, propensity case matching was applied to match clinical cases. Then, core network extraction and herb set enrichment were combined to detect core effective herb prescriptions. Effectiveness-based mutual information was used to detect strong herb-symptom relationships. This method was applied on a TCM clinical data set with 955 patients collected from well-designed observational studies. Results revealed that groups of herb prescriptions with higher effectiveness rates (76.9% vs. 42.8% for matched samples; 94.2% vs. 84.9% for all samples) compared with the original prescriptions were found. Particular patient groups with symptom manifestations were also identified to help investigate the indications of the effective herb prescriptions.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Child ; China ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Propensity Score ; Sleep Initiation and Maintenance Disorders ; drug therapy ; Young Adult

Clinical cases of TCM are used as important clinical data to record the whole process of the interaction between doctors and patients in the form of text.However,in the context of big data,there is a lack of research on the use of information covered in clinical cases.Therefore,we studied the method of extracting the symptom term from the history of present illness in TCM clinic in this paper,in order to lay the foundation for the further use of clinical cases.First,twelve thousand,three hundred and sixty-seven history data of present illness were obtained by random selection and expert review.According to the different disease types,they were divided into the two groups of the experiments:4,838 data in the diabetes group,7,529 data in the spleen and stomach disease group and 12,367 data in the mixed or combined group.A glossary of symptom terms covering 22,996 words were compiled.Then,five feature templates,such as sliding window feature,prefix and suffix character and lexical features,were selected.CRFs model was adopted to carry out named entity extraction experiment.As a result,in the open test,the performance of diabetes,spleen and stomach disease and mixed group were (0.83,0.8,0.82),(0.9,0.9,0.89) and (0.88,0.87,0.87),respectively,while the results were (0.83,0.82,0.83),(0.95,0.95,0.95) and (0.93,0.92,0.92) in the ten-fold cross validation.In conclusion,the results showed that the CRFs algorithm was an excellent sequence labeling algorithm and applied to the named entity extraction task of symptom history.