ObjectiveTo explore the therapeutic mechanism of Buchong Tiaojing prescription for rats with diminished ovarian reserve （DOR） from the perspectives of nucleotide-binding oligomerization domain （NOD）-like receptor protein 3 （NLRP3） inflammasome and ferroptosis. MethodsA total of 48 female SD rats were randomly divided into a normal group， a model group， low， medium， and high dose groups of Buchong Tiaojing prescription， and an MCC950 group， with eight rats in each group. Except the normal group， all the other groups were injected subcutaneously on the back of the neck with D-galactose to prepare the DOR rat model. From the 15th day of modeling， the rats in the low， medium， and high dose groups of Buchong Tiaojing prescription were subjected to gavage daily at doses of 14.4， 28.8， 57.6 g·kg^-1， respectively. Rats in the MCC950 group were injected intraperitoneally with MCC950 at a dose of 10 mg·kg^-1， once every other day. The interventions of all the groups lasted for 4 weeks. The estrous cycle of the rats was observed with vaginal exfoliated cell smear. Hematoxylin-eosin （HE） staining was performed to observe the development of follicles and corpus luteum in the ovary. Enzyme-linked immunosorbent assay （ELISA） was performed to detect the levels of serum sex hormones and interleukin-1β （IL-1β）. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot assay were performed to detect the mRNA and protein expression of NLRP3 inflammasome， acyl-CoA synthetase long-chain family member 4 （ACSL4）， transferrin receptor 1 （TFR1）， and glutathione peroxidase 4 （GPX4）， and oxidative stress kits were used to detect ovarian superoxide dismutase （SOD） and malondialdehyde （MDA） levels. ResultsDuring the experiment， one rat died in the high dose group of Buchong Tiaojing prescription， and a total of 47 rats were finally included in the index tests and statistics. Compared with those in the normal group， rats in the model group had significantly disturbed estrous cycles， increased number of atretic follicles， and significant disorder of serum sex hormones. The mRNA and protein expression of NLRP3 inflammasome， ACSL4， and TFR1 in ovarian tissue was up-regulated （P<0.01）， while that of GPX4 was significantly down-regulated （P<0.01）. The SOD content in the ovary was decreased significantly， while the MDA level was increased （P<0.01）. After drug intervention， the estrous cycle of rats was basically resumed， and the follicles at all levels were more structurally intact and significantly increased in number. Additionally， the levels of serum sex hormones and IL-1β were significantly improved. The mRNA and protein expression of NLRP3 inflammasome， ACSL4， and TFR1 were down-regulated， while that of GPX4 was significantly up-regulated， and the ovarian oxidative stress was alleviated （P<0.05， P<0.01）， especially in the high dose group of Buchong Tiaojing prescription and the MCC950 group. ConclusionInflammatory injury and ferroptosis occur in the ovaries of DOR rats， and the Buchong Tiaojing prescription is able to inhibit ovarian NLRP3 inflammasome， alleviate the degree of ovarian ferroptosis， and improve ovarian reserve.

Threatened abortion is a common disease of obstetrics and gynecology and one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in TCM obstetrics and gynecology， Western medicine obstetrics and gynecology， and pharmacology to deeply discuss the advantages of TCM and integrated Chinese and Western medicine treatment as well as the medication plans for threatened abortion. After discussion， the experts concluded that chromosome， endocrine， and immune abnormalities were the key factors for the occurrence of threatened abortion， and the Qi and blood disorders in thoroughfare and conception vessels were the core pathogenesis. In the treatment of threatened abortion， TCM has advantages in preventing miscarriages， alleviating clinical symptoms and TCM syndromes， relieving anxiety， regulating reproductive endocrine and immune abnormalities， personalized and diversified treatment， enhancing efficiency and reducing toxicity， and preventing the disease before occurrence. The difficulty in diagnosis and treatment of threatened abortion with traditional Chinese and Western medicine lies in identifying the predictors of abortion caused by maternal factors and the treatment of thrombophilia. Recurrent abortion is the breakthrough point of treatment with integrated traditional Chinese and Western medicine. It is urgent to carry out high-quality evidence-based medicine research in the future to improve the modern diagnosis and treatment of threatened abortion with TCM.

Based on the characteristics of postoperative gynaecological diseases， Lingnan LUO's Gynaecology has summarized the idea of "eliminating abdominal mass to help pregnancy"， and applied the elimination method in the postoperative gynaecological treatment to promote rehabilitation， prevent recurrence， and regulate menstruation in a sequential manner， which is divided into three phases of diagnosis and treatment. The first stage of postoperative rehabilitation （2 weeks after surgery） is based on the pathogenesis of profuse deficiency， profuse stasis， and easy to retain pathogens， and the treatment should focus on tonifying the positive qi and eliminating abdominal mass at the same time， commonly used in modified Sijunzi Dcoction （四君子汤） and Shenghua Dcoction （生化汤）. In the second stage of postoperative rehabilitation （2 weeks to 2-3 months after surgery）， the pathogenesis is mainly kidney deficiency and blood stasis， which should be treated by tonifying kidney and supplement essence， eliminate blood stasis and eliminate abdominal mass， and commonly use the Guishen Pill （归肾丸） with herbs that invigorating blood， dissolving stasis， and clearing the collaterals. Postoperative sequential menstrual regulation and fertility promotion stage （after the end of the postoperative rehabilitation stage， the normal anatomy of the uterine cavity and pelvis is basically restored） adopts cyclic sequential therapy， according to the characteristics of the pathogenesis of the different periods of menstruation in phases， always tonifying kidney and regulating menstruation， eliminating abdominal mass， and attaches importance to the application of four methods of eliminating abdominal mass， including invigorating blood and dissolving stasis， moving qi to resolve constraint， dissolving phlegm and dispelling dampness， resolving accumulation and removing stagnation.

This article applied the five-viscera correlation theory proposed by Professor DENG Tietao to the field of gynecology， and combined with Professor LUO Yuankai's theory of female reproductive regulation axis of traditional Chinese medicine （TCM）， to identify from the perspective of the overall transmission of diseases between the five-viscera correlation theory， which affects the female reproductive regulation axis of TCM and leads to reproductive disorders. It advocates breaking away from specialized barriers， forming a new medical concept of holism， combining multiple specialties， and using the concept of treating diseases before they occur to prevent and treat reproductive disorders caused by chronic diseases in various departments； in the meanwhile， paying attention to female patients with chronic diseases in various specialties who have been using medication for a long period of time； making sure that they understand menstruation in adolescent and childbearing females， checking the function of the ovaries in a timely manner， and protecting their fertility； so as to propose new ideas of research on TCM theories， as well as providing a new concept for clinical research on integration of TCM with Western medicine.

Objective:To explore the switch time of noninvasive-invasive mechanical ventilation sequential treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and effectively reduce the rate of tracheal intubation.Methods:A retrospective study was performed on patients with AECOPD, who underwent mechanical ventilation in emergency resuscitation room and admitted to department of respiration of Kaifeng Central Hospital Emergency Center from July 2014 to March 2019. The patients who used noninvasive mechanical ventilation (NIV) were included in NIV group (118 cases), and those who used invasive positive pressure ventilation (IPPV) were included in IPPV group (52 cases). The usage of breathing machine time, hospital days and hospital mortality were compared between the two groups. Clinical indicators such as age, gender, body temperature, respiratory rate, body mass index (BMI), mean arterial pressure (MAP), oxygenation index (PaO 2/FiO 2), respiratory index (RI), pH value, D-dimer, hemoglobin (HB), albumin, blood lactate (Lac), brain natriuretic peptide (BNP), C-reactive protein (CRP), procalcitonin (PCT), serum creatinine (SCr), white blood cell count (WBC), Glasgow coma scale (GCS), sputum excretion drainage were collected. The factors influencing the failure of NIV were analyzed by Logistic stepwise regression analysis. The receiver operating characteristic (ROC) curve was used to test the value of the NIV failure risk prediction model. Results:There was no significant difference in total mechanical ventilation time and hospital mortality between NIV group and IPPV group (hours: 65.6±11.11 vs. 66.9±12.1, 6.8% vs. 9.6%, both P > 0.05), but the hospital time in group NIV was significantly shorter than that in IPPV group (days: 12.3±2.1 vs. 14.2±2.5, P < 0.05). In NIV group, 101 cases completed NIV continuously, 17 cases of NIV failure turned to IPPV, and the failure rate of NIV was 14.4%. There were statistically significant differences in gender, PaO 2/FiO 2, RI, pH value, D-dimer, PCT, WBC, Lac, sputum excretion drainage and GCS score between NIV failure patients and NIV success patients. Logistic regression analysis showed that RI, pH value, WBC and sputum excretion drainage were independent risk factors for NIV failure [RI: odds ratio ( OR) = 3.879, 95% confidence interval (95% CI) was 1.258-11.963, P = 0.018; pH value: OR = 3.316, 95% CI was 1.270-8.660, P = 0.014; WBC: OR = 3.684, 95% CI was 1.172-11.581, P = 0.026; sputum excretion drainage: OR = 0.125, 95% CI was 0.042-0.366, P = 0.000]. The NIV failure risk prediction model based on the above independent risk factors had a good goodness of fit ( χ2 = 9.02, P = 0.34). ROC curve analysis showed that the NIV failure risk prediction model had a high predictive value for the patients with AECOPD [the area under ROC curve (AUC) was 0.818±0.051, 95% CI was 0.718-0.918, P = 0.000]. Conclusions:If patients with AECOPD have relative contraindications of NIV but still insist on using NIV, further risk stratification of NIV failure is needed. For those with RI, pH value, WBC abnormalities and sputum excretion drainage, the risk of choosing NIV is significantly increased. We need to pay more attention to the change of the condition and switch to IPPV in time to avoid exacerbation of the condition.

Objective To analyze the risk factors of failure of emergency treatment with invasive mechanical ventilation (IPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The clinical data of 122 patients with AECOPD to undergo IPPV admitted to the Emergency Center of Kaifeng Central Hospital from July 2015 to March 2018 were retrospectively analyzed. The patient's general information [gender, age, body mass index (BMI)] and the patient's body temperature (T) at initial IPPV, respiratory rate (RR), mean arterial pressure (MAP), heart rate (HR), white blood cell count (WBC), hemoglobin (Hb), electrolyte (K+, Na+ and Cl-), pH value, D-dimer, albumin, C-reactive protein (CRP), blood lactic acid (Lac), B-type brain natriuretic peptide (BNP), procalcitonin (PCT), serum creatinine (SCr), oxygenation index, respiratory index (RI), the occurrence of serious arrhythmia or not, Glasgow coma score (GCS) were statistically analyzed. The indicators with statistical significance in the univariate analysis were introduced into the multivariate Logistic regression analysis to screen out the risk factors affecting the failure of IPPV in the patients; receiver operating characteristic (ROC) curve was drawn to analyze the test effectiveness of the risk factors. Results There were totally 98 cases underwent emergency IPPV, failure in 17 cases and success in 81 cases. The levels of oxygenation index, pH value, WBC and GCS scores of the IPPV success group were significantly higher than those of the IPPV failure group [oxygenation index (mmHg, 1 mmHg =0.133 kPa): 304.10±115.35 vs. 285.93±184.64, pH value: 7.34±0.17 vs. 7.18±0.24, WBC (×109/L): 40.90±8.72 vs. 26.61±6.86, GCS score: 12.42±1.35 vs. 9.89±2.13, all P < 0.05]; the levels of RI, D-dimer, PCT, Lac and incidence of serious arrhythmia in the IPPV success group were significantly lower than those in the IPPV failure group [RI: 2.53±2.39 vs. 3.69±3.64, D-dimer (mg/L): 1.80±0.06 vs. 3.16±2.60, PCT (μg/L): 1.36±0.65 vs. 2.23±2.07, Lac (mmol/L): 3.98±0.63 vs. 7.06±3.44, incidence of serious arrhythmia: 23.46% (19/81) vs. 47.06% (8/17), all P < 0.05]. Logistic regression analysis showed that RI [odds ratio (OR) = 3.479, 95% confidence interval (95%CI)= 1.248-11.996], pH value (OR = 3.153, 95%CI = 1.256-8.656), WBC (OR = 3.364, 95%CI = 1.171-11.561), and the occurrence of severe arrhythmia (OR = 4.125, 95%CI = 0.042-0.342) were risk factors affecting the prognosis of AECOPD patients treated with IPPV (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of RI, pH value, WBC and occurrence of severe arrhthmia was 0.718 (P = 0.012), 0.832 (P = 0.008), 0.645 (P = 0.004), 0.617 (P = 0.003), and the sensitivity were 37.0%, 55.6%, 81.5%, 60.4%, the specificity were 19.1%, 26.8%, 60.3%, 83.0% respectively, that had certain value to predict the failure of using IPPV to treat patients with AECOPD. Conclusion Multiple factors may result in failure in emergency patients with AECOPD to apply invasive mechanical ventilator for treatment, that may lead to death, and RI, pH value, WBC, the occurrence of severe arrhythmia are the independent risk factors of failure in such patients using IPPV; emergency physicians should pay attention to AECOPD patients' risk factors at initial period of using IPPV in order to give early warning after assessment.

CM gynecology is one of the main courses of traditional Chinese medicine. The cultivation of the doctor-patient communication skills is a very important among the eduction of graduate students. The paper was encouraged to summarize the condition and problems of doctor-patient communication, in order to standardize CM gynecology training and improve the quality of teaching practice.

The National Excellent Course of Gynecology of Chinese Medicine is a main clinical subject of TCM,which puts emphasis on clinical application.The non-medical doctoral students are lack of the knowledge of traditional Chinese medicine and clinical experience,and the existing classroom teaching has the problem of the basic theory of traditional Chinese medicine being out of line with the clinical application,which has become the hindering factors of TCM gynecology teaching.By designing and perfecting the process of preparation before class-classroom teaching-discussion teaching-clinical probation-after class feedback,the related teaching teachers better improve the non medical doctoral students' ability to put the traditional Chinese medicine gynecology basic knowledge into clinical practice,which is well received by the students.

Objective To analyze the risk factors for the failure of noninvasive mechanical ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to help the clinical risk assessment and decision making.Methods A retrospective case control study was conducted.The patients with AECOPD undergoing NIV admitted to Kaifeng Emergency Center from June 2011 to March 2016 were enrolled,and they were divided into two groups according to whether NIV was successful or not within 12 hours.The nutritional status,blood gas analysis,serum electrolytes,D-dimer,renal function,serum pre-albumin,as well as kinetic vital signs,Glasgow coma scale (GCS) score,expression of respiratory distress,and spontaneous expectoration were recorded.Logistic forward stepwise regression analysis was used to analyze the factors for failure of NIV.Results 122 patients.with the initial NIV were enrolled,with NIV failure in 41 patients within 12 hours,accounted for 33.6％.Compared with NIV success group,the percents of respiratory rate ≥ 25 breaths/min (75.6％ vs.17.3％),expectoration disorders (78.0％ vs.19.8％),circulatory disorders (61.0％ vs.18.5％),malnutrition (61.0％ vs.11.1％),decreased serum pre-albumin (58.5％ vs.17.3％),and GCS score ＜ 12 (75.6％ vs.28.4％) in NIV failure group were significantly increased (all P ＜ 0.05).But there were no significant differences in gender,age,body temperature,blood gas analysis,D-dimer,serum creatinine between two groups.It was shown by the results of binary logistic regression analysis that respiratory rate,expectoration disorders,circulatory disorders,malnutrition,serum pre-albumin,and GCS score were the factors of NIV failure [odds ratio (OR) values were 10.879,6.338,9.860,23.273,8.862,6.774,and P values were 0.011,0.038,0.024,0.003,0.015,0.041,respectively].It was shown by the results of logistic stepwise regression analysis that respiratory rate ≥ 25 breaths/min,expectoration disorders,circulatory disorders,malnutrition,decreased serum pre-albumin,and GCS score ＜ 12 were independent risk factors of NIV failure (OR values were 6.610,5.403,5.138,8.153,4.979,5.100,and P values were 0.007,0.013,0.023,0.007,0.027,0.023,respectively).Conclusions The multiple independent risk factors can induce NIV failure within 12 hours in emergency patients with AECOPD,i.e.increased respiratory rate,expectoration dysfunction,circulatory disorders,malnutrition,decreased serum pre-albumin,and decreased GCS score.Emergency physicians should pay attention to these early risk factors in AECOPD patients,which can be taken as correct judgment and guide.

Objective To compare the difference of pregnancy outcomes between women who had a history of recurrent spontaneous abortion ( RSA) and women who were primigravida. Methods A case-control study was carried out. A total of 98 cases with a history of RSA and giving birth in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January of 2010 to September of 2014 served as the case group, while 98 primigravida giving birth at the same period in the same hospital were randomly selected as controls. The information collection form was designed following literature review before the research. All of the available data, including maternal demographic, reproductive information, medical history and present pregnancy outcomes, were collected from in-patient medical records. The number of valid information forms in case group was 91 and was 94 in control group after excluding the forms with incomplete data. The data was analyzed with SPSS 16.0 software. Results Univariate analysis results showed that maternal age, marital status, distribution of ABO blood groups, the history of infertility, clinical manifestation of threaten abortion, miscarriage treatment during pregnancy, medication of Zishen Yutai Pills for preventing miscarriage, time of delivery, adverse pregnancy outcome, and newborn sex were statistically significant different between the two groups ( P<0.05) . Logistic regression analysis results showed that there were significant differences in 5 factors between the two groups. Maternal age ( OR=1.466, 95%CI=1.267-1.698) , medication of Zishen Yutai Pills for preventing miscarriage ( OR=4.484, 95%CI=1.073-18.519) , and adverse pregnancy outcome ( OR=8.850, 95%CI=2.994-26.316) were the risk factors of RSA. Set blood type O as the classification reference, blood type A was a protective factor ( OR=0.259, 95%CI=0.088-0.765). And newborn sex was another protective factor of RSA ( OR=0.336, 95%CI=0.139-0.813). Conclusion Older women or women with blood type O are more likely to suffer from RSA than women with blood type A. Comparing with primigravida, women who had a history of RSA are more willing to accept medication of Zishen Yutai Pills for miscarriage, and women giving birth of a boy are more likely to have RSA and thereatened abortion, having high risk of adverse pregnancy outcomes particularly for the increase of gestational diabetes incidence.