High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome:A multicenter prospective study

BACKGROUND Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection(ESD).AIM To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome(PECS).METHODS In this prospective study,PECS was characterized by in-hospital fever(white blood cell count:≥10000μ/L or body temperature≥37.5℃)and abdominal pain(visual analog scale score≥30 mm during hospitalization or increased by≥20 mm from baseline at admission).High Joule heat was defined as 15390 J.Between April 2020 and April 2024,209 patients underwent colorectal ESD;those with intraoperative perforation or penetration were excluded.The remaining 202 patients were divided into the PECS and non-PECS groups.RESULTS PECS occurred in 30(14.9%)patients.Multivariate analysis revealed high Joule heat as an independent factor associated with PECS(odds ratio=7.96;95%confidence interval:2.91-21.8,P<0.01).The procedure time and presence of lesions in the right colon were not associated with PECS.CONCLUSION Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset.This thermal damage is likely a major component of the mechanism underlying PECS.

Heat stroke induced cerebellar dysfunction:A “forgotten syndrome”

We report a case of heat stroke induced acute cerebellar dysfunction, a rare neurological disease characterized by gross cerebellar dysfunction with no acute radiographic changes, in a 61 years old ship captain presenting with slurred speech and gait ataxia. A systematic review of the literature on heat stroke induced cerebellar dysfunction was performed, with a focus on investigations, treatment and outcomes. After review of the literature and detailed patient investigation it was concluded that this patient suffered heat stroke at a temperature less than that quoted in the literature.

High total Joule heat increases the risk of post-endoscopic submucosal dissection electrocoagulation syndrome after colorectal endoscopic submucosal dissection

BACKGROUND We hypothesized that thermal damage accumulation during endoscopic submucosal dissection(ESD)causes the pathogenesis of post-ESD electrocoagulation syndrome(PECS).AIM To determine the association between Joule heat and the onset of PECS.METHODS We performed a retrospective cohort study in patients who underwent colorectal ESD from May 2013 to March 2021 in Japan.We developed a novel device that measures swift coagulation time with a sensor adjacent to the electrosurgical coagulation unit foot switch,which enabled us to calculate total Joule heat.PECS was defined as localized abdominal pain(visual analogue scale≥30 mm during hospitalization or increased by≥20 mm from the baseline)and fever(temperature≥37.5 degrees or white blood cell count≥10000μ/L).Patients exposed to more or less than the median Joule heat value were assigned to the high and low Joule heat groups,respectively.Statistical analyses included Mann-Whitney U and chisquare tests and logistic regression and receiver operating characteristic curve(ROC)analyses.RESULTS We evaluated 151 patients.The PECS incidence was 10.6%(16/151 cases),and all patients were followed conservatively and discharged without severe complications.In multivariate analysis,high Joule heat was an independent PECS risk factor.The area under the ROC curve showing the correlation between PECS and total Joule heat was high[0.788(95%confidence interval:0.666-0.909)].CONCLUSION Joule heat accumulation in the gastrointestinal wall is involved in the onset of PECS.ESD-related thermal damage to the peeled mucosal surface is probably a major component of the mechanism underlying PECS.

A new way to analyze the traditional Chinese medicine syndrome:heat toxin syndrome in cerebral infarction

Objective:To establish a diagnostic system for heat toxin syndrome of acute cerebral infarction.Based on this toxin syndrome diagnostic system,the general principles of heat toxin development will be uncovered,and the critical turning point at which the heat toxin syndrome occurs will also be explored.Methods:In this study,a total of 271 hypertension patients with cerebral infarction within 72 h were recruited from the Affiliated Dongfang Hospital of the Beijing University of Chinese Medicine,the Affiliated Dongzhimen Hospital of Beijing University of Chinese Medicine,the Affiliated Renmin Hospital of Peking University,the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,the Affiliated Hospital of Shandong University of Traditional Chinese Medicine,the Affiliated Hospital of Changchun University of Traditional Chinese Medicine,the Affiliated Hospital of Hebei University of Traditional Chinese Medicine and China Meitan General Hospital from August,2008,to December,2009.The patients’Chinese medical information was recorded on days 1,3,5,7,and 14 during their hospitalizations.The medical records were recorded according to traditional Chinese medicine(TCM)theory and included the serum marker levels at the beginning and at the end of the trial.The time line was also analyzed.Results:The level of Hs-CRP,PAG,NSE,OX-LDL,and MMP-9 were abnormal and,were higher in CI patients compared to hypertension patients.In the study of the heat toxin diagnosis system,according to the entropy clustering results,30 combinations of the medical information can be sorted into the traditional syndromes,but 13 combinations cannot be sorted.To obtain more precise symptoms related to the heat toxins,a logistic regression equation was set up with the variables from the unsorted medical information;the dependent variables were fever and BP fluctuation.Weighted variables were obtained.MLP analysis demonstrated that the diagnosis model was stable and precise.The accuracy reached 83.82%.The ROC test showed that seven points of the diagnosis system was the best cutting point,with a sensitivity of 0.857 and a specificity of 0.955.Progressing stroke was related to heat toxin syndrome.When the turning point appeared,the combination of symptoms,such as coma,aphasia,gummy eyes,and halitosis,predicted the deterioration or recovery of CI.The heat toxin syndrome existed in every subtype of CI;however,the observed heat toxin levels were highest in PACI and lowest in LACI.Meanwhile,blood and sputum stasis syndromes transformed into heat toxicity were one source of heat toxin syndrome.Conclusion:Heat toxin syndrome,as well as qi/blood/sputum stasis,co-existed in the CI patients,and the transformation frequently appeared during the process.Three to five days after the onset of CI was the turning point,at which time several combinations of medical indicators make it possible to predict the development of CI.

Effect of the Haoqinqingdan decoction on damp-heat syndrome in rats with influenza viral pneumonia

Objective: To investigate the effect of Chinese medicine prescription-Haoqinqingdan decoction on damp-heat syndrome in rats with influenza viral pneumonia and its influence on the immune function. Methods: A total of 48 Wistar rats were randomly divided into the normal control group, the damp-heat syndrome model group, the Haoqinqingdan decoction group (high, medium and low dose group) and the ribavirin group. The body temperature and weight of rats in each group were recorded after modeling. After treatment for 6 d, the concentration of T lymphocyte subgroup (CD3+ CD4+ , CD3+ CD8+ ) was determined by flow cytometry. The OD value of IFN毭/IL-4 was detected by double-antibody sandwich ELISA method, and its concentration was acquired through conversion. Results: After modeling, the temperature and weight of rats in each modeling group showed the increasing trend ( P<0.01). From the second day of treatment, there was significant difference in the body mass between groups, and the rat weight of the control group was higher than in the modeling group ( P<0.05 or 0.01). With the advances of treatment, only the temperature in the medium and high dose Haoqinqingdan decoction groups declined significantly ( P<0.05). After treatment, the CD4+ /CD8+ ratio of the damp-heat syndrome model group decreased more significantly compared with the control group. Elevated CD3+ CD8+ percentages and declined CD4+ /CD8+ ratios can be observed in the low dose group and ribavirin group ( P<0.05). Moreover, the CD3+ CD4+ percentage of ribavirin group was lower than in the control group ( P<0.05). After treatment, the IFN-毭 and IFN-毭/ IL-4 levels in the peripheral blood of rats in the dampheat syndrome group were obviously higher than in the control group ( P<0.05). Conclusions: Compared with ribavirin, the high dose Haoqinqingdan decoction can improve the ratio of T lymphocyte subgroup and Th1/Th2 cell balance more effectively.

Structural and functional characteristics of microbiota in oropharynx of sub-healthy children with gastrointestinal heat retention syndrome differentiated by traditional Chinese medicine

Objective:To explore the structural and functional characteristics of microbiota in oropharynx of subhealthy children with gastrointestinal heat retention syndrome(GHRS)differentiated by traditional Chinese medicine,and screen the biometric operational taxonomic units(OTUs)to assist the clinical diagnosis.Methods:We recruited children according to the“GHRS diagnostic scale”,collected their oropharyngeal swabs,and sequenced the 16 SrDNA V4 region.We described the bacterial structure with alpha-indexes,beta-distances,and relative abundances;moreover,we screened the differential genera/OTUs with Wilcoxon rank-sum test,Metagenome Seq analysis,and linear discriminant analysis effect size(LEf Se)analysis,in which biometric OTUs were selected to construct the receiver operating characteristic curve to verify the diagnostic value.The bacterial function was predicted with Kyoto Encyclopedia of Genes and Genomes pathways according to 16S rDNA gene by using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States.Results:The study population was composed of 10 children with GHRS and 10 healthy control children.GHRS children were more likely to overeat(gluttony,P=.033).Alpha-indexes,such as Sobs,abundancebased coverage estimator,Bootstrap,and Qstat,were significantly higher in the GHRS group,while betadistances did not exhibit any significant intergroup differences.There were 9 differently distributed nonpredominant genera between the groups in Wilcoxon rank-sum test,as well as 13 non-predominant genera in Metagenome Seq analysis and 3 non-predominant OTUs in LEfSe analysis.OTU44 and OTU196 were used to construct the receiver operating characteristic curve,and the area under curve was 0.92.Predicted functions showed that pathways related to oxidative phosphorylation and carbon metabolism were enriched in healthy control samples,while the pathway related to renin secretion was remarkably enriched in GHRS samples.Conclusion:Unique oropharyngeal microbial structure and function were identified in GHRS children.OTU44 and OTU196 were specific OTUs,which could be used as biomarkers of GHRS to assist clinical diagnosis.

Effect of gastrointestinal heat retention syndrome on gut microbiota in children with upper respiratory tract infection and lung-heat syndrome

Objective:Gastrointestinal heat retention syndrome(GHRS)is associated with lung-heat syndrome and is related to recurrent respiratory infection.Upper respiratory tract infection(URTI)lung heat syndrome is common in children.The study will explore the effect of GHRS on the structure and function of gut microbiota in children with URTI lung-heat syndrome.Methods:Participants were divided into both groups using the self-developed URTI scale and the“GHRS Diagnostic Scale$Pediatric Part”:GHRS-positive children(LS group)and GHRS-negative children(L group).General information,clinical symptoms,and stool were collected.We used 16S rRNA amplicon sequencing technology to determine the gene sequence of the V3eV4 region in feces and measure the gut microbiota of the both groups at the genus level.Results:A total of 23 children were included in the both groups.There were 12 cases in the LS group and 11 cases in the L group.There was no statistical difference between the both groups in age,gender,height,weight,and body mass index.The effective sequences shared by the both groups accounted for 85.66%of the total.In the gut microbiota,there was no difference in the a diversity and the b diversity between the both groups.Compared with the L group,the LS group had a significant increase in the relative abundance of the Ruminococcus gnavus group,Prevotella-9,Staphylococcus,and Actinomyces(P<.05).The functions of the both groups of microbiota primarily concentrate on metabolism,genetic information processing,and environmental information processing.The relative abundance of signaling molecules and interactions in the LS group were higher than that in the L group(P<.05).The redundancy analysis(RDA)showed that the URTI score had the greatest impact on the distribution of microbiota.Conclusion:GHRS may affect the development of URTI lung-heat syndrome by changing the relative abundances of gut microbiota.

Clinical Study on Application of Xinrun Tongluo Method Based on the Theory of Collateral Diseases in Treating Androgenic Baldness of Blood Heat Wind Dryness Syndrome

[Objectives]To explore the intervention effect of the representative formula of Xinrun Tongluo method,Liangxue Xiaofeng Powder,on the incidence of androgenic alopecia in the syndrome of blood heat and wind dryness.[Methods]A total of 72 patients with androgenic alopecia in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine from October,2022 to June,2023 were randomly divided into a control group(36 cases,treated with Western medicine)and a treatment group(36 cases,treated with Chinese herbal formula+Western medicine).The short-term and long-term efficacy of the two groups of patients was compared.[Results]The hair microscopic signs and short-term and long-term efficacy of the treatment group were significantly better than those of the control group before and after treatment,with a statistically significant difference(P<0.05).[Conclusions]The representative formula of Xinrun Tongluo method is Liangxue Xiaofeng Powder,which has better clinical efficacy as an auxiliary Western medicine in the treatment of androgenic alopecia patients with blood heat and wind dryness syndrome,and is worthy of further promotion and application in clinical practice.

Association between gastrointestinal heat retention syndrome and respiratory tract infections in children:A prospective cohort study

Objective:To explore the relationship between gastrointestinal heat retention syndrome and the incidence of pneumonia and recurrent respiratory tract infections(RRTIs)in children.Methods:A prospective cohort study was conducted in the pediatric outpatient department of Beijing Dongfang Hospital.Children without respiratory tract infections(RTIs)were consecutively recruited according to the selection criteria.A semi-structured questionnaire was used to record traditional Chinese medicine(TCM)symptoms and demographic and physiological characteristics.Gastrointestinal heat retention syndrome was considered to be a predisposing factor and was diagnosed according to a scale with reliability and validity.The participants were followed up for 12 months.Participants and their parents or guardians were contacted via clinical interviews and telephone every 6 months.Episodes of pneumonia and RTIs were recorded in detail.Results:A total of 420 children were included.Of participants,370(88.10%)were followed up for 12 months.The mean number of RTI episodes per participant was 5.37(95%CI:5.14 to 5.60).In total,186 participants in the gastrointestinal heat retention syndrome group and 184 participants in the nongastrointestinal heat retention syndrome group completed the 12-month follow-up period.The baseline of both groups was comparable.The incidence of RRTIs in children with gastrointestinal heat retention syndrome was 1.27(95%CI:1.01 to 1.59)times that in children without gastrointestinal heat retention syndrome.Logistic regression analysis revealed that abnormally increased appetite with frequent hunger,foul breath,dry stools,and dark red or purple fingerprints were positively correlated with the incidence of pneumonia.Irascibility and feverish feelings in the palms and soles were positively correlated with the occurrence of RRTI.Conclusions:Gastrointestinal heat retention syndrome is a risk factor for RRTIs in children.Studies with larger sample sizes and longer follow-up time are warranted to confirm the degree of causal risk associated with RTIs.

Exploring the association between gastrointestinal heat retention syndrome and adult chronic eczema: A caseecontrol study

Objective:To investigate the association between gastrointestinal heat retention syndrome(GHRS)and adult chronic eczema.Methods:This caseecontrol study compared GHRS/GHRS accompanied by damp-heat syndrome(GHRSDHS)and other patient characteristics between subjects with(cases)and without chronic eczema(controls)to identify potential factors associated with this condition.Semi-structured questionnaires were used to collect data via face-to-face interviews.Participants were recruited from Dongzhimen Hospital affiliated with Beijing University of Chinese Medicine.A logistic regression analysis was performed on the collected data,and odds ratios(ORs)were calculated.Results:A total of 168 cases and 172 controls were recruited.Among the cases of adult chronic eczema,there were 79 subjects with GHRS and 68 with GHRS-DHS.Sex(P=.02,OR=0.54,95%confidence interval[CI]:0.32-0.91),GHRS(P=.04,OR=1.90,95%CI:1.02-3.51),GHRS-DHS(P<.001,OR=4.89,95%CI:2.36-10.15),high sweet food consumption(P=.04,OR=2.03,95%CI:1.03-3.97),and mental stress(P=.01,OR=2.37,95%CI:1.26-4.47)were each found to be associated with chronic eczema.Furthermore,GHRS had a weak positive correlation with eczema EASI severity as measured by the eczema area and severity index(EASI)(P=003).Conclusion:GHRS/GHRS-DHS may be associated with adult chronic eczema.In the future,prospective cohort studies with larger samples should be conducted to investigate the cause and effect association between GHRS and adult chronic eczema.

Study on the relationship between syndrome characteristics degree and inflammatory factor and negative emotional scale in"double heart disease"patients with Qi stagnation blood stasis and heart gallbladder heat stagnation

Objective:To Discuss the correlation between Hypersensitivity C-reactive Protein(Hs-CRP),Total Cholesterol(TC),Triglyceride(TG),negative emotion scale and TCM syndrome scores in“Double Heart Disease”patients with Qi stagnation blood stasis and heart gallbladder heat stagnation.Method:Fifty-two patients in Western Medicine Diagnosis of Double Heart Disease,in TCM syndrome identified as Qi stagnation blood stasis Heart gallbladder heat stagnation syndrome,detects it Hs-CRP,TC,TG levels by ELISA,use TCM Syndromes Scale to evaluate TCM Syndrome,use the Pittsburgh Sleep Quality Index(PSQI)and Self-rating symptom scale(SCL-90)to assess anxiety and sleep levels,analyze the correlation between TCM syndrome scores and Hs-CRP,TC,TG level,PSQI index,SCL-90 index.Result:There was a significant positive correlation between Hs-CRP,TG level and TCM Syndrome scores(P<0.05);TC level was postively correlated with TCM Syndrome scores,but there was no statistical significance(P>0.05);There was a significant positive correlation between PSQI index,SCL-90 index and TCM Syndrome scores(P<0.05).Conclusion:In“Double Heart Disease”patients with Qi stagnation blood stasis and heart gallbladder heat stagnation,there have characteristic syndrome changes in terms of inflammatory factor level,blood lipid level and negative emotion score;Which the above indexes can reflect the severity of TCM syndromes to a certain extent and provide the basis for the effective intervention treatment of TCM.

Study on the Characteristics of Gut Microbiota in Chronic Hepatitis B(CHB)Patients with Damp Heat Syndrome and Liver Depression and Spleen Deficiency Syndrome

Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen deficiency syndrome.Methods:According to the diagnostic criteria of Western medicine,TCM and screening exclusion criteria,65 cases of CHB with damp heat syndrome and 28 cases of CHB with liver depression and spleen deficiency syndrome were finally included in the study.All the basic information was gathered and the fresh fecal samples were collected for 16S rDNA sequencing.16S rDNA of gut microbiota was sequenced using Illumina hiseq 2,500 high-throughput sequencing platform.Based on the optimized sequence,Operational Taxonomic Units(OTU)clustering analysis and taxonomic annotation were carried out.Results:The difference in relative abundance of gut microbiota was significant between damp heat syndrome and liver depression and spleen deficiency syndrome in CHB patients.Cyanobacteria was only found in damp heat syndrome.The relative abundance of Erysipelotrichia and Subdoligranulum were higher in liver depression and spleen deficiency syndrome,while the relative abundance of Rhodospirillales,Alphaproteobacteria and Lachnospira were higher in the damp heat syndrome.LDA Effect Size(LEfSe)analysis showed that Lachnospira,Olsenella and Subdoligranulum had significant difference in species among the two TCM syndromes.Conclusion:The different characteristics of gut microbiota in the two TCM syndromes of CHB patients may play an important role in syndrome formation of TCM,which provides a new field of vision for the accurate diagnosis and treatment of TCM.

Clinical Observation of Dingchuan Decoction(定喘汤)Combined with Omazumab in Treating Acute Attack of Bronchial Asthma(Heat Asthma Syndrome)

Objective:To explore the therapeutic effect of Dingchuan Decoction combined with omazumab on acute attack of bronchial asthma.Methods:From January 2020 to November 2021,90 patients with acute asthma were treated in our hospital,which belonged to heat asthma syndrome according to TCM syndrome differentiation in our hospital.They were divided into control group and observation group with 45 cases in each group.The control group was treated with omazumab,while the observation group was treated with omazumab combined with Dingchuan Decoction.The changes of lung function,exhaled nitric oxide(FeNO),blood gas indexes and hematological indexes were observed before and after treatment,and the adverse reactions and asthma recurrence within 3 months were observed.At the same time,animal experiments were carried out to verify the curative effect of Dingchuan.Results:After treatment,the total effective rate,FeNO,pulmonary function,partial pressure of blood oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),interleukin-6(IL-6),interleukin-5(IL-5),immunoglobulin E(IgE)and asthma recurrence in 3 months in the observation group were better than those in the control group;There was no significant difference in pulse oxygen saturation(SaO_(2))and the incidence of adverse reactions between the two groups.Animal experiments show that Dingchuan Decoction can effectively improve lung inflammation.Conclusion:The combination of Dingchua Decoction and omazumab has a good curative effect in the treatment of acute attack of bronchial asthma,which can effectively improve the lung function and blood gas index of patients,reduce the levels of inflammatory factors and IgE,and has no obvious increase in adverse reactions,and effectively control the recurrence of asthma within 3 months.It can be used as an auxiliary maintenance treatment for patients with mild and moderate acute attack and clinical remission of asthma,thus reducing the utilization rate of hormones and having high application value.

Thermal hypersensitivity in a subset of irritable bowel syndrome patients

AIM： To characterize thermal hypersensitivity in patients with constipation- and diarrhea-predominant irritable bowel syndrome （IBS）. METHODS： Thermal pain sensitivity was tested among patients with diarrhea-predominant IBS （D-IBS） and constipation-predominant IBS （C-IBS） compared to healthy subjects. A total of 42 patients （29 female and 13 male; mean age 27.0 ＋ 6.4 years） with D-IBS; 24 patients （16 female and eight male; mean age 32.5 ：1：8.8 years） with C-IBS; and 52 control subjects （34 female and 18 male; mean age 27.3 ± 8.0 years） participated in the study. Thermal stimuli were delivered using a Medoc Thermal Sensory Analyzer with a 3 cm × 3 cm surface area. Heat pain threshold （HPTh） and heat pain tolerance （HPTo） were assessed on the left ventral forearm and left calf using an ascending method of limits. The Functional Bowel Disease Severity Index （FBDSI） was also obtained for all subjects. RESULTS： Controls were less sensitive than C-IBS and D-IBS （both at P 〈 0.001） with no differences between C-IBS and D-IBS for HPTh and HPTo. Thermal hyperalgesia was present in both groups of IBS patients relative to controls, with IBS patients reporting significantly lower pain threshold and pain tolerance at both test sites. Cluster analysis revealed the presence of subgroups of IBS patients based on thermal hyperalgesia. One cluster （17% of the sample） showed a profile of heat pain sensitivity very similar to that of healthy controls; a second cluster （47% of the sample） showed moderate heat pain sensitivity; and a third cluster （36% of the sample） showed a very high degree of thermal hyperalgesia. CONCLUSION： A subset of IBS patients had thermal hypersensitivity compared to controls, who reported significantly lower HPTh and HPTo. All IBS patients had a higher score on the FBDSI than controls. Interestingly, the subset of IBS patients with high thermal sensitivity （36%） had the highest FBDSI score compared to the other two groups of IBS patients.

A case of myelodysplastic syndromes with initial symptom of erythra

Myelodysplastic syndrome(MDS)is a malignant clonal disease of human hematopoietic stem cells.In this paper,a case of MDS with fever and rash as the first symptom was reported in our hospital,and the related literature was reviewed and summarized to provide ideas for the diagnosis of MDS.Case summary:The patient,male,62 years old,with systemic rash and fever as the initial symptoms,early multiple bone marrow examination showed no typical abnormalities.With the progress of the disease,bone marrow cytology,flow cytometry,molecular karyotype,chromosomal karyotype,skin biopsy and pathological diagnosis were performed,and the diagnosis was MDS.

吴志洲辨证论治尿石症经验

尿石症病因病机为下焦湿热、肾气虚弱或病久血瘀等,病位在肾与膀胱,其形成过程复杂,往往虚实夹杂,为本虚标实之证。本病的“实”一般包括湿热、气滞和血瘀,“虚”一般是指肾阴虚、肾阳虚或气血两虚。吴志洲教授临证强调结合病程,常把尿石症辨证分为三型进行论治:湿热蕴结证、气血瘀滞证、肾气不足证。尿石症初期病位在肾与膀胱等贮存尿液的器官,尿石症的治疗当重视利尿,吴教授在这个阶段以清热利湿、通淋排石为法,常以张仲景的五苓散或猪苓汤作为基本方施治,观其舌苔脉象,随症加减,或配以清热之品,或参以滋阴之药,或佐以活血化瘀药配合治之,常用药物有金钱草、猪苓、茯苓、白茅根、小蓟、泽泻、泽兰、车前子、阿胶、滑石等。吴教授临证用药注意顾护肾气、做到消中寓补、标本兼施,方选知柏地黄丸,金匮肾气丸等,还要注重健脾和养肺,分别采用健脾化湿、清养肺金等法,常以参苓白术散、补肺汤等合方共治。吴教授临证治疗尿石症,注重通调气血,无论有无瘀血征象,均可在补肾利尿化石排石的基础上,佐以通调气血以加强祛石或化石作用。一是可以加大疏散溶解结石之力,二是可以松解结石与组织间的粘连,有利于结石的排出与消散。方选逍遥散、桂枝茯苓丸、血府逐瘀汤等。此外,吴教授还提倡辨病辨证应与现代医学相结合,重用单味化石排石药物,临证常大剂量应用,如黄芪、金钱草、海金沙、鸡内金等。

庞氏安胎止血汤通过调控NLRP3炎症小体改善热证自然流产的作用机制

目的研究庞氏安胎止血汤通过调控NOD样受体蛋白3(NLRP3)炎症小体改善热证自然流产的作用机制。方法采用分子对接技术预测庞氏安胎止血汤中13种主要活性成分与NLRP3、凋亡相关斑点样蛋白质(ASC)、胱天蛋白酶1前体(pro-caspase-1)的结合活性。将60只孕1 d大鼠随机分为正常组、模型组、地屈孕酮组(0.002 g/kg)和庞氏安胎止血汤低、中、高剂量组(11.025、22.05、44.10 g/kg),每组10只。各组大鼠灌胃蒸馏水/相应药液,每天1次,连续12 d。除正常组外,其余各组大鼠采用温阳中药和米非司酮诱导热证自然流产模型。末次给药24 h后,检测大鼠血清中三碘甲状腺原氨酸(T3)、甲状腺素(T4)、白细胞介素2(IL-2)、IL-4、IL-6、IL-10、γ干扰素(IFN-γ)水平;计算流产率及子宫系数;观察大鼠妊娠子宫病理形态;检测妊娠子宫中NLRP3、ASC、caspase-1蛋白表达水平。结果分子对接结果显示,庞氏安胎止血汤13种主要活性成分与NLRP3、ASC、pro-caspase-1蛋白的结合能均小于-5 kJ/mol。动物实验结果显示,与正常组比较,模型组大鼠子宫系数和血清中IL-4、IL-6、IL-10水平均显著降低(P<0.05),流产率和血清中T3、T4、IL-2、IFN-γ水平以及妊娠子宫中NLRP3、ASC、caspase-1蛋白表达水平均显著升高(P<0.05),妊娠子宫内膜存在流产病变;与模型组比较,庞氏安胎止血汤各剂量组大鼠上述大部分定量指标均显著逆转(P<0.05),妊娠子宫内膜流产病变均有不同程度改善。结论庞氏安胎止血汤可能通过调节NLRP3炎症小体形成,下调IFN-γ、IL-2等促炎因子,上调IL-4、IL-6、IL-10等抑炎因子,从而影响母胎之间的免疫平衡,进而发挥改善热证自然流产的作用。

三仁汤加减治疗痤疮肠胃湿热证的临床疗效观察

目的探究三仁汤加减治疗肠胃湿热证痤疮的临床疗效。方法选取2023年4月至2024年4月本院收治90例肠胃湿热证痤疮患者为研究对象,采用奇偶数字为分组策略,将上述样本归入不同组别(n=45),命名为对照组、观察组,分别予以常规治疗、加施三仁汤加减治疗。比较两组中医症候积分、血清相关因子水平、临床疗效及生活质量。结果治疗后,观察组中医症候积分、血清相关因子水平、临床疗效及生活质量等方面均优于对照组(P均<0.05)。结论加施三仁汤加减治疗肠胃湿热证痤疮,可明显促进症状消退、更好调节血清相关因子水平,同时也能显著提升临床疗效和患者生活质量。

黄连汤合柴龙逆萎汤联合四联疗法治疗慢性非萎缩性胃炎伴糜烂临床研究

目的:观察黄连汤合柴龙逆萎汤联合四联疗法治疗慢性非萎缩性胃炎(CNAG)伴糜烂的临床效果。方法:选取2020年6月—2023年6月于安阳市中医院治疗的144例肝胃不和兼脾胃湿热型CNAG伴糜烂患者,采用随机数字表法分为对照组和观察组各72例,2组均采用常规四联疗法治疗,观察组加用黄连汤合柴龙逆萎汤加减治疗。2组均治疗4周。治疗前后评估2组患者的中医证候评分,检测血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-8(IL-8)]水平及胃功能指标[胃泌素-17(G-17)、胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)],评估胃黏膜糜烂评分、慢性炎症评分,统计治疗期间不良反应发生情况。比较2组的临床疗效。结果:治疗4周后,观察组总有效率高于对照组(P<0.05)。2组中医证候主症积分、次症积分、总积分及胃黏膜糜烂评分、慢性炎症评分均较治疗前降低(P<0.05),观察组以上5项评分值均低于对照组(P<0.05)。2组TNF-α、IL-1β、IL-8、PGⅡ水平均较治疗前降低,G-17、PGⅠ水平均较治疗前升高,差异均有统计学意义(P<0.05)。观察组TNF-α、IL-1β、IL-8、PGⅡ水平均低于对照组(P<0.05),G-17、PGⅠ水平均高于对照组(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在四联疗法基础上加用黄连汤合柴龙逆萎汤治疗肝胃不和兼脾胃湿热型CNAG伴糜烂患者能够有效缓解症状,提高临床疗效,减轻机体炎症及胃黏膜糜烂程度,安全性较高。

清胆煎治疗胆石症临床研究

目的:观察清胆煎治疗胆石症的临床疗效。方法:采用便利抽样法选取2021年1月至2023年3月无锡市中医医院收治的胆石症患者98例,根据给药方式不同分为对照组和试验组,每组49例。对照组给予常规西药对症治疗,试验组在对照组治疗的基础上给予清胆煎治疗。观察两组患者治疗前后症状改善情况、肝胆功能[总胆汁酸(total bile acid,TBA)、总胆红素(total bilirubin,TBiL)、天冬氨酸转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine transaminase,ALT)]、应激指标[超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、肾上腺素]及临床疗效、不良反应发生情况。结果:试验组有效率为95.92%,对照组有效率为81.63%,试验组有效率高于对照组,差异有统计学意义(P<0.05)。试验组治疗后肠鸣音消退时间、腹胀痛消退时间、发热消退时间、胆囊壁厚度等改善情况均优于对照组,差异有统计学意义(P<0.05)。两组治疗后TBA、TBiL、AST、ALT低于治疗前,差异有统计学意义(P<0.05),且试验组治疗后TBA、TBiL、AST、ALT低于对照组,差异有统计学意义(P<0.05)。试验组治疗后SOD高于对照组,MDA、肾上腺素低于对照组,差异有统计学意义(P<0.05)。试验组不良反应发生率为8.16%,对照组不良反应发生率为4.08%,两组比较,差异无统计学意义(P>0.05)。结论:清胆煎治疗胆石症肝胆湿热证,能改善患者症状和肝胆功能,减轻机体应激反应。