Observation on the Nursing Effect of Ginger Moxibustion on Gastrointestinal Symptoms in Patients with Heart Failure Due to Yang Qi Deficiency

Objective:To evaluate the nursing measures and effects of ginger moxibustion in the treatment of heart failure(yang qi deficiency type)with gastrointestinal symptoms.Methods:86 patients with heart failure(yang qi deficiency type)accompanied by gastrointestinal symptoms who were admitted to the hospital between January 2023 and January 2024 were selected and divided into 43 cases in each group by random number table grouping;Group I implemented integrated care,while Group II adopted conventional care.The indicators of care were compared between the two groups.Results:After the nursing care,the digestive symptom scores of Group I were lower than those of Group I,and the psychological scores were lower than those of Group II(P<0.05).Conclusion:Ginger moxibustion can improve gastrointestinal symptoms and enhance the psychological health of patients with heart failure(yang qi deficiency type)with gastrointestinal symptoms.

Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

Transcriptomic and metabolomic analysis of the effects of Zhenwu decoction on kidney yang deficiency pattern in chronic kidney disease

Objective:To explore the kidney yang deficiency pattern(KYDP)in a chronic kidney disease(CKD)rat model and the mechanisms underlying the effects of Zhenwu decoction(ZWD)by conducting tran-scriptomic and metabolomic analyses.Methods:Adriamycin(ADR)combined with hydrocortisone(HC)was used to induce CKD with KYDP in rats.ADR was injected into the tail vein twice.HC was injected intramuscularly for 8 weeks.ZWD was administered by gavage for 8 weeks.The general condition was observed,24-h urine protein was detected,serum corticosterone,triiodothyronine,thyroxine,TSH,testosterone,cAMP,and cGMP levels were determined,and pathological analysis was conducted.Transcriptomic and metabolomic analyses were conducted to screen differentially expressed genes(DEGs),differentially expressed metabolites(DEMs),and differentially expressed pathways(DEPs).The core DEMs and DEGs were input to Metab-oanalyst 5.0 to identify the pathways affected by ZWD.Results:In the HC group,KYDP symptoms were observed.Compared with control group,the levels of 24-h urine protein,TSH,and cGMP significantly increased(all P<0.01),and corticosterone,triiodothyronine,thyroxine,and cAMP significantly decreased(all P<0.01)in the HC group.After ZWD intervention,the levels of above-mentioned indicators could be reversed to some extent.Pathological analysis in the HC group revealed kidney lesions.DEGs in the ZWD group were mainly associated with pathways such as nucleotide synthesis and endocrine pathways.In the ZWD group,differences in biosynthesis of unsat-urated fatty acids and butanoate metabolism were observed.The following pathways were significantly affected by ZWD:arachidonic acid metabolism,valine,leucine,and isoleucine biosynthesis,linoleic acid metabolism,and alpha-linolenic acid metabolism.Conclusion:ZWD can be used to treat KYDP in CKD through regulating arachidonic acid metabolism,valine,leucine,and isoleucine biosynthesis,linoleic acid metabolism,and alpha-linolenic acid metabolism.

Characterization of CircRNA-Associated CeRNA Networks in Folate Deficiency-Induced Neural Tube Defects

Objective Circular RNAs(circRNAs)participate in several important pathological processes and have been used in the diagnosis and treatment of various diseases.This study aimed to investigate the role of circRNAs in neural tube defects(NTDs).Method We characterized circRNA-associated competitive endogenous RNA(ceRNA)networks in brain tissue of low folate-induced NTDs mouse at embryonic day 13.5 by high-throughput sequencing.The expression levels of Circzfp644,miR-20-5p and Gas7 were detected by RT-PCR.Gas7 and Circzfp644functions were determined by miRNA-mimics and inhibitors in mouse teratocarcinoma cells(F9 cells),and luciferase gene reporter assay was assessed in the F9 cells.In addition,the expression levels of Circzfp644,miR-20-5p and Gas7 were determined by Nanostring in human NTDs tissues.Results We detected 57 circRNA transcripts,16 miRNAs,and 148 mRNAs that were significantly dysregulated in NTDs brain tissues compared with their expression levels in control(normal)tissues.Circzfp644 shared miRNA response elements with the growth arrest specific 7(Gas7)gene and competitively bound with miR-20-5p to increase the expression of Gas7.Downregulation of Circzfp644and Gas7 and upregulation of miR-20-5p were found in human NTD tissue.Conclusion This study provides new perspectives on the role of circRNAs in nervous system development and the pathogenesis of NTDs.

Abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type

Objective:To explore the abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type.Methods:The 30 healthy individuals included in the method were from the Physical Examination Center of Anhui Provincial Hospital of Traditional Chinese Medicine,and the 60 rheumatoid arthritis patients included were from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.The disease activity score of patients with rheumatoid arthritis was evaluated using VAS score and DAS28 score,joint symptoms and spleen deficiency syndrome score were evaluated using graded quantification method,immune inflammation indicators were detected using relevant instruments,inflammatory cytokines were detected using ELISA method,macrophage markers were detected using FCM method,and pathway gene expression was detected using RT-qPCR;Evaluate the predictive effect of circ-CBLB and miR-486-5p on disease activity in rheumatoid arthritis using ROC curves.Results:(1)miR-486-5p,CD14^(+)CD86^(+),ESR,CRP,RF,Anti CCP Ab,IL-6,TNF in patients with rheumatoid arthritis-αThe levels of circ-CBLB,CD14^(+)CD163^(+),IL-4,and IL-10 were significantly higher than those of healthy individuals;(2)The expression level of circ-CBLB in patients with rheumatoid arthritis is positively correlated with CD14^(+)CD163^(+),and negatively correlated with miR-486-5p and CD14^(+)CD86^(+);The expression level of miR-486-5p is negatively correlated with CD14^(+)CD163^(+)and positively correlated with CD14^(+)CD86^(+);There is a negative correlation between CD14^(+)CD86^(+)and CD14^(+)CD163^(+);ESR is negatively correlated with circ-CBLB,and positively correlated with miR-486-5p,CD14^(+)CD86^(+),CRP;CRP is negatively correlated with circ-CBLB,CD14^(+)CD163^(+),and positively correlated with CD14^(+)CD86^(+),ESR;(3)The expression level of circ-CBLB in patients with rheumatoid arthritis is negatively correlated with joint tenderness,morning stiffness,lack of qi and lazy speech,and postprandial abdominal distension score;The expression level of miR-486-5p is positively correlated with the scores of joint tenderness and decreased appetite.(4)The ROC curve shows that in terms of circ-CBLB,ESR,CRP,VAS,and DAS28 AUC are 0.662(P=0.032),0.658(P=0.035),0.516(P=0.830),and 0.791(P=0.000),respectively.In terms of miR-486-5p,ESR,CRP,VAS,and DAS28 AUC were 0.566(P=0.385),0.511(P=0.883),0.592(P=0.223),and 0.727(P=0.003),respectively.Conclusion:The abnormal expression of circ CBLB and miR-486-5p in peripheral blood mononuclear cell of patients with rheumatoid arthritis of spleen deficiency and dampness excess type is related to inflammatory polarization markers,immune inflammation,disease activity,joint symptoms and spleen deficiency syndrome of rheumatoid arthritis,and the low expression of circ CBLB and high expression of miR-486-5p have certain predictive value for disease activity of rheumatoid arthritis.

Proteomics analysis of IBS-D with spleen and kidney yang deficiency

Objective:To investigate the molecular mechanism underlying the development of diarrhea-predominant irritable bowel syndrome (IBS-D) with spleen and kidney yang deficiency (SKYD) using a proteomics approach.Methods:Male Sprague-Dawley rats (n =22) were divided into IBS-D (n =12) and normal control (n =10) groups.SKYD was then modeled in IBS-D rats by a combination of acetic acid enema,bondage,rectal dilation,tail stimulation,and Senna gavage.Colon tissue samples were subsequently collected and examined by Q Exactive mass spectrometry to identify differentially expressed proteins between the two groups.Results:The occurrence of SKYD/IBS-D was associated with ribosomal protein S23 (Rps23),protein phosphatase 2 catalytic subunit alpha (Pp2a),and growth factor receptor-bound protein 2 (Grb2),which are involved in the ribosome,neurotrophin signaling,and Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathways.Conclusion:These data suggest that SKYD/IBS-D pathophysiology likely involves inflammation,cell growth,apoptosis,stress granule formation,immune activation,loss of epithelial cell integrity,and visceral hypersensitivity.

High Density Lipoprotein Phospholipids as a Marker of Coronary Heart Disease of Shen-Yang Deficiency Syndrome

Objective: To seek a new biochemical index for diagnosis of coronary heart disease (CHD) of shen-Yang deficiency syndrom (CHD-SYD). Methods: Sixty-one patients with CHD were divided into 3 groups according to their TCM Syndrome type, 10 patients in the group without Xin-Qi deficiency (Group A), 25 in the group with Xin-Qi deficiency but without Shen-Yang deficiency (Group B) and 26 in the group both with Xin-Qi deficiency and Shen-Yang deficiency (Group C). Levels of 17-hydroxy-corticoste-roid in urine (urinary 17-OHCS) per 24 hrs, and serum level of high density lipoprotein cholesterol (HDL-C) and high density lipoprotein phospholipid (HDL-PL) in them were determined in synchrostep and compared with those in the control group of 23 healthy aged persons, urinary 17-OHCS per 24 hrs was taken as the diagnostic standard to screen a new index for diagnosis of Shen-Yang deficiency Syndrome, and preliminary appraisal to the index was made. Results: Serum HDL-PL in the CHD-SYD patients( Group C) was 616+157 mg/L, which was obviously lower than that in the patients of Group A and B. With low HDL-PL(<650 mg/L) used as the index to diagnose CHD-SYD, the sensitivity was 73%, the specificity 86% and the accuracy 80%. Conclusion: HDL-PL <650 mg/L could be adopted as an index for CHD-SYD diagnosis, which is simple and practical.

Clinical observation on efficacy of compound of warming yang, descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with Yin-Yang deficiency and blood stasis syndrome

Objective:To observe the clinical efficacy of compound of owarming yang,descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome.Methods:Seventy-six patients of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome were randomly divided into observation group and control group,thirty-eight cases in each group.The control group was given conventional western medicine treatment,while the observation group took compound of owarming yang,descending turbidity and dredging collaterals orally on the basis of conventional western medicine treatment.The course of treatment covered for one month.Before and after treatment,we observed the scores of traditional Chinese medicine symptoms,indicators of renal function[serum creatinine(Scr),blood urea nitrogen(BUN),microalbuminuria(MALB)],indicators of glucose metabolism[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbAlc)],indicators of hemorheology[plasma viscosity(PV),platelet aggregation rate(PAR),fibrinogen(FIB)],Cystatin-C(Cys-C),C-reactive protein(CRP)in the two groups.Results:After treatment,the clinical effect of the observation group was significantly better than the control group(P<0.05).The scores of traditional Chinese medicine symptoms,indicators of renal function(Scr、BUN、UAER),indicators of glucose metabolism(FPG、2hPG、HbAlc),indicators of hemorheology(PV、PAR、FIB),Cys-C and CRP in the two groups were decreased significantly compared with those before treatment(P<0.05),and the decrease in the observation group was superior to that in the control group(P<0.05).Conclusion:Compound of warming yang,descending turbidity and dredging collaterals has remarkable efficacy in treating of diabetic kidney disease patients with yin-yang deficiency and blood stasis syndrome by alleviating clinical symptoms,glucose metabolism,renal function and microcirculatory disturbance,and the mechanism related to alleviation of microinflammation.

Observation of tongue picture and tongue and nailbed microcirculation before and after blood dialysis in 125 uremic patients with deficiency of kidney-yang

using a WZD—1 microcirculation microscope,we observed the tongue tipand nail-bed microcirculation of uremic patients with deficiency of kidney-yangbefore and after blood dialysis.The results showed that the pathological basis ofuremia with deficiency of kidney-yang may be microcirculation disturbance,in-crease of metabolites and water retention.The effusion from capillary loops intongue tip may be one of the pathogenetic factors of a swollen and jaggedtongue.The flow rate of blood in capillary loops in the nail-bed was apparentlyabnormal and markedly improved after blood dialysis.The weighted integral ofnail-bed microcirculation decreased from moderately abnormal (4.99±1.52) toapproximately normal (1.98±0.97) (P【0.01).Microcirculation seems to be a sensi-tive criterion for reflecting the pathologic changes of uremia with deficiency ofkidney-yang.

Discuss ion on the Correlation Between Yang Deficiency&Cold-dampness and Malignant Tumors Based on"Diseases producing the liquid that is clear and chill all result from coldness"

Tumor is defined as a kind of chronic diseases by the World Health Organization.The integrative traditional Chinese and western medicine works well on the treatment of tumors,even in advanced patients or patients with recurring and metastatic tumor.However,the pathogenic mechanism of tumors is still unclear.Therefore,based on the 19 th pathogenesis in Yellow Emperor's Internal Class that"Diseases producing the liquid that is clear and chill all result from coldness",the paper explore s the etiology pathogenesis of malignant tumors,and the correlation between which and tumor recurrence and metastasis,and also discusses the rules for the treatment of tumors at various stages with great method of warming yang for dispelling cold.

A Study on the Law of Birth and Formation of Yang-Deficiency Constitution Based on the Theory of Five Movement and Six Qi

Objective:To explore the law of birth and yang deficiency constitution based on the theory of five movements and six qi,as well as to provide a new way to better realize the prevention of yang deficiency constitution.Methods:The data of TCM quality table and luck data were collected via questionnaires.According to the data of from the TCM quality table,the respondents were divided into yang deficiency constitution group and non-yang deficiency group.According to the luck data,the distributions of gestational age were compared between the two groups.Results:A total of 175 questionnaires were collected,of which 89 were non-yang deficiency constitution and 86 were yang deficiency constitution.The proportion of Ding year(15.1%)in the yang deficiency group was significantly higher than that in non-yang deficiency group(5.6%),in which the difference was statistically significant(P<0.05).Conclusion:The possibility of yang deficiency constitution is higher.

加味苓桂术甘汤对阳虚水停证慢性心力衰竭患者TGF-β1、TNF-α、NT-proBNP及心室重构的影响

目的探究加味苓桂术甘汤对阳虚水停证慢性心力衰竭患者TGF-β1、TNF-α、NT-proBNP及心室重构的影响。方法将2017年12月至2020年11月六安市中医院收治的98例阳虚水停证慢性心力衰竭患者纳入本研究,随机分为两组,各49例。对照组行西医常规治疗,观察组在此基础上行加味苓桂术甘汤口服治疗,治疗6个月后检测心功能,血清肿瘤坏死因子(tumor necrosis factor,TNF)-α、转化生长因子(transforming growth factor,TGF)-β1、同型半胱氨酸(homocysteine,Hcy)、氨基末端脑钠素原(amminoterminal brain sodium minogen,NT-proBNP)水平并比较临床疗效。结果两组患者治疗后各项指标均较治疗前明显改善(P<0.05)。其中观察组患者治疗后血清TNF-α、TGF-β1、Hcy、NT-proBNP、左室舒张末期内径、左室收缩末期内径和中医证候总积分低于对照组,左室射血分数、6 min步行距离和临床疗效高于对照组(P<0.05)。结论加味苓桂术甘汤治疗阳虚水停证慢性心力衰竭可减轻患者炎症反应,预防心室重构,提高临床疗效。

Δ4-3-oxosteroid-5β-reductase deficiency: Responses to oral bile acid therapy and long-term outcomes

BACKGROUND Disorders of primary bile acid synthesis may be life-threatening if undiagnosed,or not treated with primary bile acid replacement therapy. To date, there are few reports on the management and follow-up of patients with Δ4-3-oxosteroid 5β-reductase(AKR1 D1) deficiency. We hypothesized that a retrospective analysis of the responses to oral bile acid replacement therapy with chenodeoxycholic acid(CDCA) in patients with this bile acid synthesis disorder will increase our understanding of the disease progression and permit evaluation of this treatment regimen as an alternative to the Food and Drug Administration(FDA) approved drug cholic acid, which is currently unavailable in China.AIM To evaluate the therapeutic responses of patients with AKR1 D1 deficiency to oral bile acid therapy, specifically CDCA.METHODS Twelve patients with AKR1 D1 deficiency, confirmed by fast atom bombardment ionization-mass spectrometry analysis of urine and by gene sequencing for mutations in AKR1 D1, were treated with differing doses of CDCA or ursodeoxycholic acid(UDCA). The clinical and biochemical responses to therapy were monitored over a period ranging 0.5-6.4 years. Dose adjustment, to optimize the therapeutic dose, was based on changes in serum biochemistry parameters,notably liver function tests, and suppression of the urinary levels of atypical hepatotoxic 3-oxo-Δ4-bile acids measured by mass spectrometry.RESULTS Physical examination, serum biochemistry parameters, and sonographic findings improved in all 12 patients during bile acid therapy, except one who underwent liver transplantation. Urine bile acid analysis confirmed a significant reduction in atypical hepatotoxic 3-oxo-Δ4 bile acids concomitant with clinical and biochemical improvements in those patients treated with CDCA. UDCA was ineffective in down-regulating endogenous bile acid synthesis as evidenced from the inability to suppress the urinary excretion of atypical 3-oxo-Δ4-bile acids. The dose of CDCA required for optimal clinical and biochemical responses varied from 5.5-10 mg/kg per day among patients based on maximum suppression of the atypical bile acids and improvement in serum biochemistry parameters, and careful titration of the dose was necessary to avoid side effects from CDCA.CONCLUSION The primary bile acid CDCA is effective in treating AKR1 D1 deficiency but the therapeutic dose requires individualized optimization. UDCA is not recommended for long-term management.

基于UPLC-Q-Orbitrap HRMS代谢组学和16S rRNA基因测序探讨骨疏丹补肾机制

目的 整合代谢组学和肠道微生物组学的研究策略探讨骨疏丹(Gushudan, GSD)预防氢化可的松诱导的肾阳虚证(kidney-yang deficiency syndrome, KYDS)大鼠的补肾作用机制。方法 分别采用超高效液相色谱-四级杆/静电场轨道阱高分辨质谱(UPLC-Q-Orbitrap HRMS)的非靶向代谢组学和16S rRNA基因测序分析的肠道微生物组学方法,分析正常对照组、肾阳虚证模型组、骨疏丹给药组和阳性对照组大鼠粪便代谢物谱与肠道菌群组成,采用Pearson相关分析探讨内源性差异代谢物与差异菌群之间的相关性。结果 基于UPLC-Q-Orbitrap HRMS的代谢组学方法在正负离子模式下共发现骨疏丹参与调控肾阳虚症的22种差异代谢物,如色氨酸、鹅去氧胆酸、肌酐和油酸酰胺等,主要涉及氨基酸代谢、胆汁酸代谢、能量代谢和脂质代谢。基于16S rRNA测序分析发现骨疏丹在属水平显著上调普雷沃氏菌(Prevotellaceae)的相对丰度(P<0.05),显著下调颤杆菌(Oscillibacter)的相对丰度(P<0.05)。相关性分析结果表明甘胆酸和鹅去氧胆酸与在属水平显著改变的普雷沃氏菌(Prevotellaceae)显著正相关(P<0.05),而与考拉杆菌(Phascolarctobacterium)显著负相关(P<0.05)。二十二碳六烯酸与毛螺菌(Lachnospiraceae)显著负相关(P<0.05)。结论 骨疏丹通过良性调节内源性代谢和肠道菌群结构发挥补肾作用,为中药通过肠-肾轴治疗疾病提供新的思路和方法。

肾衰泄浊汤对腺嘌呤致肾阳虚型慢性肾衰竭大鼠下丘脑-垂体-肾上腺轴的影响

目的:评估肾衰泄浊汤对腺嘌呤灌胃致慢性肾衰竭(CRF)大鼠肾阳虚相关指标及下丘脑-垂体-肾上腺(HPA)轴的影响。方法:将大鼠随机分为正常组、模型组、中药低、中、高剂量组及西药组,采用腺嘌呤灌胃构建肾阳虚型CRF大鼠模型。造模结束后,中药低、中、高剂量组分别给予不同浓度的肾衰泄浊汤(9.375、18.75、37.5 g/kg),西药以氯沙坦钾作为阳性对照,正常组给予0.9%氯化钠溶液,每天1次,连续28 d。观察大鼠的一般活动,记录体重、尿量和饮水量指标;检测血清中的血肌酐(Scr)和血尿素氮(BUN)含量;HE染色观察肾组织病理改变;采用ELISA法测定大鼠血清中促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)以及皮质酮(CORT)的含量水平。结果:肾衰泄浊汤能改善CRF大鼠肾阳虚相关的弓背蜷缩、背部发凉、爬行缓慢、反应迟钝和体重增长缓慢表现,降低饮水量和尿量;减轻肾组织病理破坏,降低血清Scr和BUN水平;提高血清CRH、ACTH和CORT的含量。结论:肾衰泄浊汤能减轻腺嘌呤致CRF大鼠的肾阳虚证型相关表现,降低血清中的Scr与BUN含量,减轻肾组织病理损伤,并提高HPA轴中的CRH、ACTH和CORT水平。

曾普华从“癌毒驱动-态靶调治-阴阳复衡”论治结直肠癌

随着中西医结合治疗的不断发展,结直肠癌的治疗手段逐渐多元化及复杂化。临床中往往根据病理、分期、基因表达等,灵活采用多种方法联合或配合进行治疗。由于西医治疗体系难以评价中医证候的影响,单纯的分证论治不足以构建肠癌的中医诊疗体系。因此基于“癌毒驱动-态靶调治-阴阳复衡”的诊治思路,通过探讨结直肠癌与“癌毒-态靶”理论的密切联系,深入了解其关键病机,正确把握其态靶——即结直肠癌患者的发病整体态势及其具体症状或异常指标,采取相应的治疗措施十分重要。应用以人为本、宏观调态、微观打靶的辨证论治思路,总结出结直肠癌热毒、痰湿、虚寒、气血亏虚4种常见证靶,再分别选用相应靶方调整患者整体内环境,同时选择对应靶点靶药,使态靶同调,达到精准治疗、调整阴阳平衡、恢复稳态的治疗目的。

17α-hydroxylase/17,20 carbon chain lyase deficiency caused by p.Tyr329fs homozygous mutation:Three case reports

p.Tyr329fs is a cytochrome P450c17 mutation among Chinese individuals.However,data on 17-α-hydroxylase deficiency caused by cytochrome P450c17 p.Tyr329fs homozygous mutation are lacking.This paper is a case report of three patients homozygous for p.Tyr329fs who were diagnosed with 17-α-hydroxylase deficiency between 2005 and 2019.CASE SUMMARY Case 1 presented with hypertension,hypokalemia,sexual infantilism and delayed bone age.The patient had a 46,XY karyotype,was homozygous for p.Tyr329fs and was recently treated with dexamethasone 0.375 mg qn.Case 2 presented with hypokalemia,sexual infantilism,osteoporosis and delayed bone age.The patient had a 46,XY karyotype,was homozygous for p.Tyr329fs and was treated with dexamethasone 0.75 mg qn at the last follow-up.Serum potassium and blood pressure could be maintained within normal range for cases 1 and 2.Case 3 presented with amenorrhea,sexual infantilism,osteopenia and delayed bone age.The patient had a 46,XX karyotype,was homozygous for p.Tyr329fs and was treated with dexamethasone 0.75 mg qn and progynova 1 mg qd.Outpatient follow-up revealed an adrenocorticotropic hormone(8 AM)of<5.00 pg/mL.CONCLUSION The homozygous p.Tyr329fs mutation usually manifests as a combined deficiency,and definitive diagnosis depends primarily on genetic testing.

EFFECTS OF MOXIBUSTION ON THE IMMUNITY AND THE CENTRAL NERVOUS TRANSMITTERS IN MICE WITH YANG DEFICIENCY

In the present paper, the effects of moxibustion on the immune organs, on the multiplication reactivity of the splenic lymphocyte and the reactivity to the IL - 2, and on the transmitters in brain tissues of the mice with "yang deficiency" were studied. 30 mice were randomly divided into three groups: the normal group, the peng deficiency control group and the moxibustion treated group. Our study found out that in the mice of yang deficienly, the atrophy of the immunt organs was prevented, the reactivity of the splenocyte and the reactivity to IL - 2 were heightened, the amounts of the DA, NE and E in brain were increased significantly after moxibustion on the Point Shengshu. It can be held that moxibustion may protect the immune organs and regulate the immunity of the mouse with yang deficienly, and the effects may be contributed to the increase of the nervous transmitters in the brain.

慢性心力衰竭患者阳虚血瘀证与心功能及血清NT-proBNP表达的相关性及二者对预后的影响

【目的】探究慢性心力衰竭患者阳虚血瘀证与心功能及血清B型氨基端利钠肽原(NT-proBNP)表达的相关性以及二者对患者预后的影响。【方法】选取2019年1月至2021年1月期间唐山市中医医院收治的320例慢性心力衰竭患者作为研究对象,根据中医辨证分型结果,将辨证为阳虚血瘀证的160例患者作为观察组,将辨证为气虚血瘀证或气阴两虚证的160例患者作为对照组;并对慢性心力衰竭阳虚血瘀证患者出院后进行为期1年的随访,根据随访结果,将患者分为良好预后组104例和不良预后组56例。采用Spearman相关性分析患者中医证型与血清NT-proBNP水平及心功能指标左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、每分钟搏出量(SV)、心排血量(CO)之间的相关性;采用多因素Logistic回归分析探讨影响患者不良预后的危险因素。【结果】(1)观察组患者的血清NT-proBNP水平及LVEDD值均明显高于对照组,LVEF、SV、CO值均低于对照组,差异均有统计学意义(P<0.05或P<0.01)。(2)Pearson相关性分析结果显示,慢性心力衰竭患者中医证型与血清NT-proBNP水平及LVEDD值呈正相关,与LVEF、SV、CO值呈负相关,差异均有统计学意义(P<0.01)。(3)慢性心力衰竭阳虚血瘀证患者不良预后组血清NT-proBNP水平及LVEDD值均明显高于良好预后组,LVEF、SV、CO值均低于良好预后组,差异均有统计学意义(P<0.01)。(4)血清NT-proBNP联合心功能指标对预后不良评估的曲线下面积(AUC)为0.942。Logistic回归分析结果显示,血清NT-proBNP高水平、LVEDD高水平均为影响慢性心力衰竭阳虚血瘀证患者发生不良预后的危险因素(P<0.01),而LVEF高水平、SV高水平、CO高水平均为保护因素(P<0.05或P<0.01)。【结论】慢性心力衰竭阳虚血瘀证患者血清NT-proBNP水平升高,阳虚血瘀证与血清NT-proBNP水平及心功能关系密切,且NT-proBNP水平及心功能与患者预后有关。

温阳逐瘀汤对肾阳虚证大鼠急性脑缺血损伤后Wnt3a、β-catenin表达的影响

目的:观察温阳逐瘀汤对肾阳虚证大鼠急性脑缺血损伤后缺血脑组织无翅型MMTV整合位点家族成员3A(Wnt3a)、β-连环蛋白(β-catenin)表达的影响,并探讨温阳逐瘀汤防治肾阳虚证大鼠脑缺血损伤的作用机制。方法:将176只雄性SD大鼠分为空白组(Blank组,44只)和肾阳虚组(SYX组,132只);成功建立肾阳虚证大鼠模型后随机分为假手术组(Sham组,44只)、脑缺血模型组(MCAO组,44只)、温阳逐瘀汤组(WYZY组,44只)。WYZY组大鼠灌胃温阳逐瘀汤,MCAO组与Sham组灌胃等体积蒸馏水。各组在术后1 d,运用Zea Longa评分标准进行大鼠神经行为学评分,于术后3、7、14、21 d取材,每个时间选11只大鼠。苏木精-伊红(HE)染色观察神经细胞形态变化;运用酶联免疫吸附法(ELISA)检测各组大鼠血浆环磷酸腺苷(cAMP)、环磷酸鸟苷(cGMP)含量;免疫蛋白印迹法(Western Blot)检测缺血侧脑组织Wnt3a、β-catenin表达;实时荧光定量聚合酶链式反应(RT-PCR)检测Wnt3a、β-catenin mRNA表达。结果:与Blank组比较,SYX组cAMP含量下降(P<0.05)、cGMP含量升高(P<0.05)。HE染色结果显示,MCAO组细胞排列紊乱、大量细胞坏死、细胞膜消失、细胞核固缩,呈明显的脑缺血损伤表现;WYZY组前期细胞排列紊乱、部分细胞坏死,随着时间的延长,细胞损伤减轻,细胞排列逐渐密集,坏死细胞减少,脑缺血损伤显著改善。与MCAO组、Sham组比较,WYZY组cAMP含量升高,cGMP含量降低(P<0.05)。与MCAO组比较,WYZY组1、3、7、14、21 d神经行为学评分均降低(P<0.05)。与Blank组、Sham组比较,MCAO组、WYZY组缺血脑组织3、7、14、21 d Wnt3a、β-catenin表达均有增加(P<0.05);与MCAO组比较,WYZY组Wnt3a、β-catenin表达均增加(P<0.05),7 d Wnt3a达到峰值,14 dβ-catenin达到峰值。与Blank组、Sham组比较,MCAO组、WYZY组3、7、14、21 d Wnt3a、β-catenin mRNA表达均有增加(P<0.05);与MCAO组比较,WYZY组Wnt3a、β-catenin mRNA表达增加(P<0.05),7 d Wnt3a mRNA达到峰值,14 dβ-catenin mRNA达到峰值。结论:温阳逐瘀汤可改善肾阳虚证大鼠cAMP、cGMP水平及肾阳虚病理状态,可能通过上调Wnt3a、β-catenin表达减轻急性脑缺血损伤,减少神经功能缺损。