This paper summarized the experience of Professor FANG Dingya in staged treatment of Sjögren's syndrome from the perspective of dryness toxin. It is believed that the cause of Sjögren's syndrome is externally-contracted dryness， consumption of essence and fluid， congenital and acquired essence deficiency， depleted essence and insufficient blood， and the core mechanism is internal accumulation of dryness toxin. The treatment can be divided into three stages， that is dryness toxin transforming into fire-heat， damp-heat and phlegm-stasis， from the perspective of dryness metal qi transformation. It is emphasized to dispel pathogen mainly， to clear and moisten with yin-nourishing medicinals in supplementation， and to treat by stages based on syndrome differentiation. For dryness toxin with fire-heat， it is suggested to moisten dryness， resolve toxins and subdue fire， with self-made Runzao Jiedu Decoction （润燥解毒汤） in modification. For dryness toxin with damp-heat， the method of nourishing yin， clearing heat and draining dampness should be used， and Chunze Decoction （春泽汤） in modification is suggested. For dryness toxin with phlegm-stasis， it is recommended to unblock collaterals， disperse phlegm and dissipate stasis， with self-made Sanyu Xiaotan Decoction （散瘀消痰汤） in modification.

Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.

Objective: To investigate the epidemiological characteristics of clusters of hand, foot and mouth disease (HFMD) in kindergartens and schools in Jinshan District, Shanghai Municipality from 2016 to 2021, so as to provide insights into improving the prevention and control measurements of HFMD in Jinshan District. Methods: Data of HFMD cases in Jinshan District from 2016 to 2021 were collected through Chinese Disease Prevention and Control Information System, and data pertaining to HFMD clusters in kindergartens and schools were also collected. The scale, temporal distribution, regional distribution and distribution of cluster places were descriptively analyzed. Results: Totally 338 HFMD clusters involving 974 cases were identified in kindergartens and schools in Jinshan District from 2016 to 2021, with an average attack rate of 9.89%. The number of cases in each cluster ranged from 2 to 12 cases, with a median number of 2 (interquartile range, 1) cases, and there were 223 clusters involving 2 cases, accounting for 65.98%. The duration of clusters ranged from 1 to 16 days, with a median duration of 4 (interquartile range, 3) days. HFMD peaked from April to June (136 clusters, 40.24%) and from September to December (176 clusters, 52.07%). All the 11 streets and towns (high-tech zones) were reported HFMD clusters, and the three largest number of clusters were reported in Zhujing Town (72 clusters, 21.30%), Shanyang Town (63 clusters, 18.64%) and Tinglin Town (40 clusters, 11.83%). There were 268 HFMD clusters in kindergartens (79.29%) and 70 in schools (20.71%), and the prevalence of HFMD clusters was higher in kindergartens than in schools (35.51% vs. 17.03%; χ2=31.507, P<0.001). Conclusions HFMD clusters in kindergartens and schools showed seasonal characteristics from 2016 to 2021 in Jinshan District, which predominantly occurred in Zhujing Town, Shanyang Town and Tinglin Town, and kindergartens were the main places.

Objective:To analyze the characteristics of respiratory tract adenovirus infection in hospitalized children and the correlation between adenovirus infection and wheezing symptoms.Methods:The detection of adenovirus in 48 153 children with acute respiratory tract infection in Children’s Hospital of Hebei Province from January 1st, 2014 to December 31st, 2019 was retrospectively analyzed. The adenovirus infection in different years, different seasons and different age groups was compared and analyzed. Multivariate conditional Logistic regression was used to analyze the related factors of wheezing symptoms caused by adenovirus infection in children.Results:Of the 48 153 children, adenovirus was positive in 603 children, the positive rate was 1.25%. No significant difference was found in the positive rate between boys and girls ( X2=0.592, P = 0.442). There was no significant difference in adenovirus positive rate between different years ( X2=10.251, P = 0.068). Adenovirus was detected in four seasons, and the positive rate in winter and spring (1.50%, 1.31%) was higher than those in summer and autumn (0.98%, 1.08%), and the difference in the detection rate of adenovirus in different seasons was significantly ( X2=15.490, P = 0.001). The highest detection rate was 2.13%(199/9 339 cases) in the group of ~ ≤ 6 years old, and the lowest detection rate was 0.82% (146/17861 cases, 0.82%) in children under 1 year old. There was significant difference among different age groups ( X2=89.580, P < 0.001). The detection rate of adenovirus in wheezing group (362/21 015 cases, 1.72%) was higher than that in non-wheezing group (241/27 138 cases, 0.89%), and the difference was significant ( X2=66.702, P < 0.001). Multivariate conditional Logistic regression analysis showed that atopic constitution, history of recurrent respiratory tract infections, obesity, premature birth and maternal pregnancy-induced hypertension were risk factors for children’s wheezing symptoms associated with adenovirus infection ( OR=7.463, 5.772, 2.992, 2.119, 1.714). Conclusions:Adenovirus infection rate in winter and spring is higher than that in summer and autumn, and children aged 3-6 years are susceptible. The detection rate of wheezing children is higher than that of non-wheezing children. Atopic constitution, history of recurrent respiratory tract infections, obesity, premature birth and maternal pregnancy-induced hypertension were the risk factors for children’s wheezing symptoms associated with adenovirus infection.

Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.

Objective To explore the expression of mitochondrial ubiquitin ligase(MITOL)in the cere-brospinal fluid from patients with postherpetic neuralgia(PHN). Methods A total of 45 patients who were diag-nosed with PHN in our hospital from August 2015 to December 2016 were enrolled in this study,and 38 gender-and age-matched patients with lumbar disc herniation were recruited as IDH group.The MITOL was measured by the ELISA and Western blot methods.The correlation between the expression of MITOL in cerebrospinal fluids and clinical characteristics of patients with PHN was evaluated.Results The expression of MITOL was significantly in-creased in cerebrospinal fluids of patients with PHN compared with IDH,and it was associated with age and the pain intensity(P<0.05).Logistic regression analysis showed age(OR,2.717)and the pain intensity(OR,3.042) were risk factors for PHN. Conclusions The expression of MITOL is significantly increased in the cerebrospinal fluid of PHN,which may be associated with age and pain intensity.

BACKGROUND: Clopidogrel is one of the most commonly used anti-platelet agents in cardiovascular diseases. We analyzed the relationship between the platelet function analyzer (PFA)-200 P2Y (INNOVANCE PFA-200 System, Siemens Healthcare, Germany) results and occurrence of major adverse cardiac events (MACEs) in Korean patients with recent-onset acute coronary syndrome (ACS) taking clopidogrel. METHODS: Between August 2013 and June 2016, we prospectively enrolled 106 patients with recent-onset ACS who had been treated with clopidogrel. We obtained blood samples and measured closure time (CT) using the PFA-200 P2Y test. Patients were divided into two groups on the basis of a CT cut-off value of 106 seconds. We compared patient characteristics and various MACEs that occurred during the follow-up period. RESULTS: The CTs for 78 patients exceeded the cut-off value. At the time of these analyses, 11 patients had been diagnosed with MACEs. In the time-to-event analysis, there was a difference between the two groups (P<0.001). After adjusting other variables associated with MACE occurrence, CT value was the strongest predictor of MACEs, with a 7.30-fold occurrence risk (P=0.002). CONCLUSIONS: We found a strong relationship between CT and MACE risk in Korean patients with recent-onset ACS taking clopidogrel. Accordingly, PFA-200 P2Y results could be used as a predictive marker for MACE risk in such patients.
Acute Coronary Syndrome* ; Blood Platelets* ; Cardiovascular Diseases ; Delivery of Health Care ; Follow-Up Studies ; Humans ; Prospective Studies

Objective To explore the value of spectral CT imaging in the preoperative evaluation on histodifferentiation of rectal adenocarcinoma.Methods 90 patients with rectal adenocarcinoma underwent dual-phase enhanced spectral CT scan,and were divided into well,moderately and poorly differentiated adenocarcinoma groups according to the pathology.Single-energy images with energy levels from 40 to 140 keV were generated by GSI Viewer software,and the slope K value of the energy curves were calculated.Iodine concentrations were derived from iodine-based material-separation images and normalized to the iodine concentrations in the aorta. ROC curves were derived to evaluate the differentiation diagnosis efficiency of normalized iodine concentration (NIC)and slope K in rectal adenocarcinoma,respectively.Results There were 22,50 and 18 cases in the well,moderately and poorly differentiated group,respectively.The iodine concentration,NIC and slope K value were statistically different both in the arterial and venous phase (P<0.05).According to the ROC curve,the diagnostic value of NIC was close to that of the slope K,with the sensitivity>76% and the specificity>74% in the arterial phase,and the sensitivity>77% and the specificity>70% in the venous phase by choo-sing the appropriate threshold.Conclusion The spectral CT can provide a new method for preoperatively evaluating the histodiffer-entiation of rectal adenocarcinoma.

Objective To explore the mechanism and inhibition of botulinum toxin type A (BTXA) on hypertrohic scar fibroblasts.Methods The cells were treated by 0 (control),0.2,0.4,0.8 U/ml BTXA for 48 h.Cell viability was detected by MTT assay.Cell apoptosis was detected by Hoechst staining.Cell cycle was detected by flow cytometry.The level of cell cycle related protein D1 (Cyclin D1),proliferation nuclear antigen (PCNA) and activation of phosphatidylinositol 3 kinase (PI3K) / protein kinase B (AKT) signaling pathway were assayed by western blot.Results Compared with control group(0.75±0.07),0.2,0.4,0.8 U/mL BTXA(0.59 ± 0.06,0.43 ± 0.04,0.34± 0.03) inhibited hypertrohic scar fibroblasts cell viability,increased cell apoptotic rate[control group(2.38±0.24)％;BTXA(15.79±1.54)％,(27.32±2.69)％,(38.46±3.90)％],down-regulated the expression of Cyclin D1(control group 1.57±0.18;BTXA 0.93±0.07,0.42±0.04,0.35±0.03) and PCNA(control group 1.46±0.16;BTXA 0.50±0.05,0.59±0.05,0.37±0.03),inhibited the expression of PI3K(control group 0.98±0.06;BTXA 0.49±0.04,0.50±0.04,0.39±0.03) and the phosphorylation of AKT(control group 1.38±0.08;BTXA 0.97±0.06,0.60±0.04,0.29± 0.02),made cell cycle arrested in G1 phase,The difference was statistically significant (P＜0.05).Conclusion These results suggested BTXA inhibit proliferation via blocking the activation of PI3K/AKT signal pathway and down-stream related cell cycle related protein.

Objective To discuss the effects and influence of preoperative and postoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative diabetic retinopathy (PDR).Methods A retrospective research was performed on 42 PDR eyes from January 2015 to February 2016 in the Second Affiliated Hospital of Nanchang University,who received either intravitreal 0.05 mL conbercept injection 7 days before 23G vitrectomy (group A,n =22) or intravitreal 0.05 mL conbercept injection at the end of 23 G vitrectomy (group B,n =20).The operative time,postoperative vitreous hemorrhage (VH),intraoperative and postoperative other differences of clinical indicators and postoperative best-corrected visual acuity (BCVA) between the two groups were compared.Results The average operation time,intraoperative electric coagulation hemostasis rate,iatrogenic hiatal incidence and intraoperative hemorrhage rate of group A were lower than those of group B (all P ＜ 0.05).BCVA at 6 months after surgery did not differ significantly between two groups (P ＞ 0.05),but the difference was statistically significant between pre-operation and post-operation (P ＜ 0.05).The incidences of early (≤ 1 month) postoperative VH were 18.2％ (4 eyes) and 15.0％ (3 eyes) in group A and B,respectively (P ＞ 0.05).The incidences of later (＞ 1 month) postoperative VH were 27.3％ (6 eyes) and 0 in group A and B,respectively,the difference was statistically significant (P ＜0.05).The percentages of reoperation were 13.6％ (3eyes with postoperative VH) and 10.0％ (2 eyes with traction retinal detachment) respectively in group A and B.The average times of supplementary laser photocoagulation were (2.3 ± 1.0) times and (1.4 ±0.6) times in group A and B,respectively in follow-up period (P ＜ 0.05).Conclusion The adjunctive use of intraoperative intravitreal injection of conbercept can prevent effectively postoperative VH and decrease conveniently the time of supplementary laser photocoagulation in 23G vitrectomy for PDR,as well as the preoperative adjunctive use can decrease the operation time,intraoperative complications and incidences of early postoperative VH.