Sixty-one Cases of Angina Pectoris due to Coronary Heart Disease Treated by External Use of the Paste of Nitrum and Realgar Powder on Zhiyang(GV 9)

In order to inquire into the therapeutic effects of Xiao Shi Xiong Huang San (硝石雄黄散the Nitrum and Realgar Powder), one of the Dunhuang Prescription, on angina pectoris due to coronary heart disease (APCHD), the authors have treated 61 cases of APCHD by externally applying paste of the powder on Zhiyang (GV 9), with another 30 cases of APCHD treated with the nitroglycerin paste on Zhiyang as the controls. The results showed that the total effective rate was 82% and markedly effective rate 31.2% in the treatment group (the Paste of Nitrum and Realgar Powder), and the total effective rate was 46.6% and markedly effective rate 23.2% in the control group (the nitroglycerin paste). The difference in therapeutic effects between the two groups was very significant (P<0.01), indicating that the therapeutic effect of the former was significantly superior to that of the latter.

Discussion on the Prevention and Treatment of COVID-19 Causing Lung Disease and Heart Damage Based on Lei Zhongyi's Theory of Intermingled Phlegm,Blood Stasis and Toxin

Novel coronavirus infection not only damages lung function,but also causes myocardial injury,elevated myocardial enzymes and heart failure,especially for patients with basic heart diseases who develop COVID-19,the first consideration should be the protection of cardiac function.Based on the theory of intermingled phlegm,blood stasis and toxin of heart disease put forward by Master Lei Zhongyi,the dialectical treatment thinking of COVID-19 patients from the concept of damage of phlegm,blood stasis and toxin to the heart were discussed.During the diagnosis,critical stage and recovery period of COVID-19,expectorant and blood-activating agents,heat and detoxification agents can be added to promote lung and asthma,free Bizheng and remove blood stasis,calm the heart and calm the mind,and promote the recovery of cardiopulmonary functions.

Impact of continuous care on cardiac function in patients with lung cancer complicated by coronary heart disease

BACKGROUND Despite sharing similar pathogenic factors,cancer and coronary heart disease(CHD)occur in comparable populations at similar ages and possess similar susceptibility factors.Consequently,it is increasingly commonplace for patients to experience the simultaneous occurrence of cancer and CHD,a trend that is steadily rising.AIM To determine the impacts of continuing care on lung cancer patients with CHD following percutaneous coronary intervention(PCI).METHODS There were 94 lung cancer patients with CHD following PCI who were randomly assigned to the intervention group(n=38)and the control group(n=41).In the intervention group,continuing care was provided,while in the control group,routine care was provided.An evaluation of cardiac and pulmonary function,medication compliance,a 6-min walk test,and patient quality of life was performed.RESULTS Differences between the two groups were significant in left ventricular ejection fraction,6-min walk test,oxygen uptake,quality of life and medication compliance(P<0.05).In comparison with the control group,the enhancement in the intervention group was more significant.The intervention group had more patients with high medication compliance than the control group,with a statistically significant difference(P<0.05).CONCLUSION After undergoing PCI,lung patients with CHD could benefit from continued care in terms of cardiac and pulmonary function,medications compliance,and quality of life.

Effectiveness of chest radiography,lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure

Hydrostatic pulmonary edema is as an abnormal in-crease in extravascular water secondary to elevatedpressure in the pulmonary circulation, due to conges-tive heart failure or intravascular volume overload.Diagnosis of hydrostatic pulmonary edema is usuallybased on clinical signs associated to conventional ra-diography findings. Interpretation of radiologic signsof cardiogenic pulmonary edema are often question-able and subject. For a bedside prompt evaluation,lung ultrasound(LUS) may assess pulmonary conges-tion through the evaluation of vertical reverberationartifacts, known as B-lines. These artifacts are relatedto multiple minimal acoustic interfaces between smallwater-rich structures and alveolar air, as it happens incase of thickened interlobular septa due to increase of extravascular lung water. The number, diffusion and in-tensity of B lines correlates with both the radiologic andinvasive estimate of extravascular lung water. The inte-gration of conventional chest radiograph with LUS canbe very helpful to obtain the correct diagnosis. Com-puted tomography(CT) is of limited use in the work upof cardiogenic pulmonary edema, due to its high cost,little use in the emergencies and radiation exposure.However, a deep knowledge of CT signs of pulmonaryedema is crucial when other similar pulmonary condi-tions may occasionally be in the differential diagnosis.

EXTRAVASCULAR LUNG WATER AND VENTILATORY MANAGEMENT IN CHILDREN AFTER OPEN HEART SURGERY

The accumulation of extravascular lung water （EVLW） after cardiac surgery of congenital heart disease may predicted from the preoperative level of pulmonary blood flow. This accumulation of EVLW may adversely affect ventilatory parameters. Lung compliance （LC）, cardiac index （CI）, blood arterial oxygen tension （PaO2）, left atrial pressure （LAP）and EVLW were measured serially immediately postoperative in two groups of children after complete repair of congenital heart disease contrasted by their level of pulmonary blood flow: Tetralogy of Fallot （TOF, n=10, 4.6±1.9 years） and ventrvcular septal defect with pulmonary arterial hypertension （VSD+PAH, n=10, 5.4±2.0 years）.Using a double indicator-dilution technique （DIDT） the EVLW peaked at the 16th hour postoperation in TOF group and at the 8 th hour postoperation inthe VSD with PAH group. During the first 24 hours after surgery the EVLW was consistently higher in the VSD with PAH group （P【0.01）. There was a negative correlation between the EVLW and LC, CI and PaO2 and no correlation between the EVLW and LAP. In three hypoxemic patients of the VSD with PAH group the LC deteriorated while the EVLW was elevated. After treatment with positive end expiratory pressure （PEEP） the hypoxemia corrected as the LC increased and the EVLW decreased, with no change in the CI. Thus, measurement of EVLW provides a sensitive method for explaining changes in LC, that may lead to a more rational adjustment of mechanical ventilator parameters.

Mechanisms of Huanglian Jiedu Decoction in treating coronary heart disease and type 2 diabetes mellitus based on network pharmacology

Objective:To explore the common mechanism of Huanglian Jiedu Decoction in treating coronary heart disease and type 2 diabetes by network pharmacology.Methods:All chemical components and targets of the four drugs in Huanglian Jiedu Decoction were retrieved through TCMSP,and the genes were standardized through Uniprot database.Acquire disease targets related to coronary heart disease and diabetes in OMIM and GeneCards databases.The network diagram of"drug-component-target-disease"is constructed by using the software of cytopscape 3.7.2,the PPI network diagram of protein interaction is constructed by using STRING database,and the network diagram of"drug-disease"core target is constructed by using the software of cytopscape 3.7.2.DAVID's online database platform was used to analyze GO biological process and KEGG pathway enrichment of common targets of Huanglian Jiedu Decoction in treating coronary heart disease and type 2 diabetes.Results:103 active ingredients of Huanglian Jiedu Decoction were retrieved,including 140 acting targets,5342 coronary heart disease targets,114 diabetes targets,and 14 common intersection targets of drugs and diseases,involving AR,PPARG,TNF,IL6,CCL2,VEGFA,PON1,etc.The GO biological process analysis results in 98 biological processes,10 cell components and 10 molecular functions.Among them are positive regulation of gene expression,positive regulation of nitric oxide biosynthesis process,Extracellular space,cytokine activity,steroid hormone receptor activity and other biological processes;The enrichment analysis of KEGG pathway yielded 20 signal pathways(P≤0.05).It mainly involves Malaria,cancer in cancer,HIF-1 signaling pathway,TNF signaling pathway,NOD-like receptor signaling pathway,PI3K-Akt signaling pathway,etc.Conclusion:Huanglian Jiedu Decoction"treats different diseases at the same time"coronary heart disease and type 2 diabetes have the characteristics of multiple components,multiple targets and multiple pathways,which provide theoretical basis for Huanglian Jiedu Decoction to treat coronary heart disease and type 2 diabetes in clinic,but the key targets and pathways of Huanglian Jiedu Decoction to treat diseases still need further experimental verification.

Nursing care of a patient with programmed cell death protein-1 immunotherapy-related myocarditis combined with coronary heart disease

This report introduced and summarized the nursing care experience for a senior patient with lung cancer and developed programmed cell death protein 1(PD-1)immunotherapy-related myocarditis combined with coronary heart disease(CHD)after receiving said treatment.In this case,immune myocarditis with CHD occurred shortly after implementing the PD-1 immunotherapy,yet the patient presented no clinical symptoms.Frequent nursing attention and close observation are so required for monitoring the patient’s status and updating the physicians for a swift control of the myocarditis.For this case,nursing care procedures vital for the successful recovery of the patient included condition observation,position management,pre-and postcoronary angiography care,infection prevention,hemorrhage prevention,venous access port maintenance,pain care,trachea care,psychological care,diet care,environment management,and health education.After receiving effective,successful treatment and care,the patient was discharged after 13 days of treatment with generally satisfying overall conditions.

慢性阻塞性肺疾病和肺心病患者血浆TXB_2、6-Keto-PGF_(1a)的测定

目的 :探讨慢性阻塞性肺疾病 (COPD)和肺心病患者血浆血栓素 (TXB2 )和 6 -酮 -前列环素F1a(6 -Keto -PGF1a)的变化及临床意义。方法 :采用放射免疫法测定血浆TXB2 、6 -Keto -PGF1a的浓度。结果 :COPD患者血浆TXB2 与对照组比较无明显差异 (P >0 0 5 )。肺心病急性发作期TXB2 明显高于对照组及COPD组 ,差异有显著性 (P <0 0 1)。COPD组及肺心病组 6 -Keto -PGF1a与对照组比较差异有显著性 (P <0 0 1)。结论 :TXB2 在肺心病肺动脉高压的发生发展中起着重要的作用。

基于百合病探析从心肺论治抑郁症

探讨抑郁症与百合病之间的联系,并基于百合病的治疗原则探讨抑郁症的治疗方法。研究表明,百合病与心肺功能密切相关,其病机为心肺阴虚内热。抑郁症的病机、症状与百合病相似,均与心肺功能失调有关。以百合病为切入点,探讨心肺在情志调节和气血调节中的作用,及抑郁症与百合病发病的联系。提出从心肺论治抑郁症,通过调节心肺功能、调养气血实现阴阳平衡、神安魄宁,从而治疗抑郁症。治疗方法包括辨虚实以达阴平阳秘,调心肺以期神安魄宁,和气血以待形神合一。

Correlation analysis between lung ultrasound scores and pulmonary arterial systolic pressure in patients with acute heart failure admitted to the emergency intensive care unit

Background:No convenient,inexpensive,and non-invasive screening tools exist to identify pulmonary hypertension(PH)-left heart disease(LHD)patients during the early stages of the disease course.This study investigated whether different methods of lung ultrasound(LUS)could be used for the initial investigation of PH-LHD.Methods:This was a single-center prospective observational study which was performed in the Zigong Fourth People’s Hospital.We consecutively enrolled patients with heart failure(HF)admitted to the emergency intensive care unit from January 2018 to May 2020.Transthoracic echocardiography and LUS were performed within 24 h before discharge.We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure(PASP).Bland-Altman plots were generated to inspect possible bias,and receiver operating characteristic(ROC)curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD.Results:Seventy-one patients were enrolled in this study,with an overall median age of 79(interquartile range:71.5–84.0)years.Among the 71 patients,36(50.7%)cases were male,and 26(36.6%)had an intermediate and high echocardiographic probability of PH.All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH(P<0.05).The correlation coefficient(r)between different LUS scoring methods and PASP was moderate for the 6-zone(r=0.455,P<0.001),8-zone(r=0.385,P=0.001),12-zone(r=0.587,P<0.001),and 28-zone(r=0.535,P<0.001)methods.In Bland-Altman plots,each of the four LUS scoring methods had a good agreement with PASP(P<0.001).The 8-zone and 12-zone methods showed moderately accurate discriminative values in differentiating patients with an intermediate and high echocardiographic probability of PH(P<0.05).

严季澜从肝论治百合病经验

严季澜教授认为,百合病多因平素情志不舒,或偶遇外界情志刺激而引发,内因是情志失调、气机不畅,伤及心、肝、肺三脏,脏腑功能受损,心不藏神,肝气郁结,肺失宣肃,故而为病。严教授认为,百合病的核心病机是气机不畅,郁久化热,热伤阴津,终致气阴两虚,治疗上重视疏通气机,而后益气养阴,宁心清热,故从肝论治,调节气机升降,合清凉生津之品,达到气血流畅、阴阳调和的目的。阴虚内热证,治法为清热润肺,方选百合地黄汤加减;痰热内扰证,不能过分应用凉药,而是清化痰热,方选黄连温胆汤加减;心肺气虚证,治法为益气安神,方选甘麦大枣汤合生脉散;肝郁气滞证,治法为疏肝理气,方选小柴胡汤加减。

Exclusive cigar smoking in the United States and smoking-related diseases: A systematic review

BACKGROUND Little information has been published on the risks of cigar smoking.Since 1990 cigar smoking has become more prevalent in the United States.AIM To summarise the evidence from the United States relating exclusive cigar smoking to risk of the major smoking-related diseases.METHODS Literature searches detected studies carried out in the United States which estimated the risk of lung cancer,chronic obstructive pulmonary disease(COPD),heart disease,stroke or overall circulatory disease in exclusive cigar smokers as compared to those who had never smoked any tobacco product.Papers were identified from reviews and detailed searches on MEDLINE.For each study,data were extracted onto a study database and a linked relative risk database.Relative risks and 95%CIs were extracted,or estimated,relating to current,former or ever exclusive cigar smokers,and meta-analysed using standard methods.Sensitivity analyses were conducted including or excluding results from studies that did not quite fit the full selection criteria(for example,a paper presenting combined results from five studies,where 86%of the population were in the United States).RESULTS The literature searches identified 17 relevant publications for lung cancer,four for COPD and 12 for heart disease,stroke and circulatory disease.These related to 11 studies for lung cancer,to four studies for COPD and to eight studies for heart disease,stroke or overall circulatory disease.As some studies provided results for more than one disease,the total number of studies considered was 13,with results from four of these used in sensitivity analyses.There was evidence of significant heterogeneity in some of the meta-analyses so the random-effects estimates are summarized below.As the results from the sensitivity analyses were generally very similar to those from the main analyses,and involved more data,only the sensitivity results are summarized below.For lung cancer,relative risks(95%CI)for current,former and ever smokers were respectively,2.98(2.08 to 4.26),1.61(1.23 to 2.09),and 2.22(1.79 to 2.74)based on 6,4 and 10 individual study estimates.For COPD,the corresponding estimates were 1.44(1.16 to 1.77),0.47(0.02 to 9.88),and 0.86(0.48 to 1.54)based on 4,2 and 2 estimates.For ischaemic heart disease(IHD)the estimates were 1.11(1.04 to 1.19),1.26(1.03 to 1.53)and 1.15(1.08 to 1.23)based on 6,3 and 4 estimates,while for stroke they were 1.02(0.92 to 1.13),1.08(0.85 to 1.38),and 1.11(0.95 to 1.31)based on 5,3 and 4 estimates.For overall circulatory disease they were 1.10(1.05 to 1.16),1.11(0.84 to 1.46),and 1.15(1.06 to 1.26)based on 3,3 and 4 estimates.CONCLUSION Exclusive cigar smoking is associated with an increased risk of lung cancer,and less so with COPD and IHD.The increases are lower than for cigarettes.

小儿先天性心脏病术后肺部感染转归相关因素的前瞻性队列研究

目的评估小儿先天性心脏病(CHD)术后肺部感染转归情况,并探讨分析转归失败的相关因素。方法选取2022年1月—2023年12月新疆医科大学第一附属医院小儿心胸外科收治的CHD术后肺部感染患儿173例为研究对象,根据入院28 d的预后情况将患儿分为预后不良组61例和预后良好组112例。多因素Logistic回归分析CHD术后肺部感染患儿预后不良的影响因素;采用R软件构建CHD术后肺部感染患儿预后不良的列线图预测模型;受试者工作特征(ROC)曲线评估列线图模型预测CHD术后肺部感染患儿预后不良的区分度,校准曲线评估模型的一致性。结果预后不良组患儿免疫力缺陷、机械通气时间≥48 h、纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级、左心室射血分数(LVEF)≤40%、WBC>12×109/L、NEU>70%、降钙素原(PCT)>0.5μg/L、白蛋白(Alb)≤35 g/L的比例均大于预后良好组(χ^(2)/P=7.273/<0.001、15.949/<0.001、9.414/0.002、10.473/0.001、29.572/<0.001、21.811/<0.001、10.154/0.001、11.864/0.001);多因素Logistic回归分析结果显示,免疫力缺陷、机械通气时间≥48 h、NYHA心功能分级Ⅲ~Ⅳ级、LVEF≤40%、WBC>12×10^(9)/L、NEU>70%、Alb≤35 g/L、PCT>0.5μg/L是CHD术后肺部感染患儿预后不良的独立危险因素[OR(95%CI)=7.381(2.513~21.677)、5.295(1.801~15.568)、8.928(3.030~26.300)、5.563(1.962~15.774)、3.108(1.590~6.076)、2.058(1.429~2.963)、3.415(1.211~9.626)、5.269(1.799~15.429)],并构建列线图模型;验证结果显示,ROC曲线下面积(AUC)为0.969(95%CI 0.945~0.992),模型预测CHD术后肺部感染患儿发生预后不良风险与实际风险的一致性良好(χ^(2)=7.086,P=0.681)。结论免疫力、机械通气时间、NYHA心功能分级、LVEF、WBC、NEU、Alb、PCT为影响CHD术后肺部感染患儿发生预后不良的独立危险因素,以此构建的列线图模型区分度与一致性均良好。

河南长垣张氏中医内科学术流派传承与临证经验

作为河南省首批优质中医学术流派,河南长垣张氏中医内科流派传承脉络清晰,学术思想鲜明,临床经验丰富,是中原医学流派的重要代表之一。该流派创立者张清连在地域文化影响下,传承家学,儒医兼通,擅长运用中医药诊治肺病、脾胃病、痹证、男科疾病等中医内科疾病。第二代传承人张超然主张为医重在治病救人,除精通家传医学外,在中医外科、妇科、儿科方面也多有创新和突破。第三代传承人张华甫为豫北名老中医,从事中医临床工作60余年,临证注重从天人合一、形神合一的整体观念入手,强调三因制宜和四诊合参,擅长诊治中医内科疑难杂病,尤其在脾胃病和肝胆病的辨证论治方面具有独特的学术见解和丰富的临床经验;张庆瑞擅长治疗中医妇科和内科杂病,对肝病和神智疾患有所研究,注重培补脾胃,顾全正气。第四代传承人张景祖为河南省名中医,擅长运用中医药诊治肺病、脾胃病、痹证、男科疾病、肾病、糖尿病、脑病等疑难杂症,致力于清肺平喘丸、补肾生精丸等流派代表经验方,胃肠病中医疗法、痹证中医疗法等流派特色疗法的临床运用和研究;张昱在继承家学基础之上,师从国医大师王绵之等中医名家,擅长运用传统中医药或中西医结合的方法治疗急慢性肾炎、肾病综合征、慢性肾功能衰竭、糖尿病肾病、痛风性肾病、高血压性肾损害、紫癜性肾炎、狼疮性肾炎等各类肾脏疾病。

基于网络药理学和分子对接技术探讨血府逐瘀汤“异病同治”治疗冠心病和缺血性脑卒中的作用机制

目的 通过网络药理学方法结合分子对接技术探讨血府逐瘀汤“异病同治”治疗冠心病和缺血性脑卒中的作用机制。方法 在TCMSP数据库检索并结合文献筛选血府逐瘀汤11味中药的活性成分和作用靶点,通过Uniprot数据库匹配靶点官方名称。从OMIM、DrugBank、DisGNET、TTD、GeneCards数据库获取冠心病和缺血性脑卒中相关疾病靶点,取交集靶点,构建“单味药—共有靶点—疾病”网络。建立蛋白间相互作用网络,利用Centiscape插件筛选关键靶点,利用MetaScape数据库进行GO功能分析和KEGG通路富集分析。通过AutoDockTools-1.5.6进行分子对接预测。结果 筛选后得到血府逐瘀汤活性成分192个,作用靶点394个;与冠心病和缺血性脑卒中相关且排序靠前的通路有脂质和动脉粥样硬化、缺氧诱导因子-1、松弛素、核因子-κB信号通路等,主要与脂质代谢、炎症反应、氧化应激、血管生成和细胞凋亡等生物学过程相关。本方中主要活性成分木犀草素、山柰酚、柚皮素与靶点蛋白蛋白激酶1、白蛋白、胰岛素结合较好。结论 基于网络药理学的方法发现血府逐瘀汤通过多靶点、多途径治疗冠心病和缺血性脑卒中,且多个成分表现出良好的活性;可能通过抗氧化、抗炎、抑制细胞凋亡、调节激素水平、促进血管生成等作用,改善局部缺血缺氧状态,发挥“异病同治”作用。

消水圣愈汤治疗老年肺源性心脏病临床观察

目的探讨消水圣愈汤对老年慢性肺源性心脏病(CPHD)患者血栓前状态指标及血清白细胞介素-8(IL-8)和肽素(Copeptin)水平的影响。方法将117例老年CPHD患者随机分为对照组(58例)和试验组(59例)。对照组予常规对症治疗,试验组在对照组的基础上予消水圣愈汤治疗,两组均治疗4周。比较两组临床疗效、血栓前状态指标及血清IL-8、Copeptin水平。结果治疗后,试验组总有效率为94.92%(56/59),高于对照组的79.31%(46/58)(P<0.05)。与对照组比较,试验组治疗后血浆黏度、血浆纤维蛋白原(FIB)水平、血清D-二聚体(D-D)、血管性假血友病因子(vWF)、内皮素(ET-1)水平较低,血清IL-8、Copeptin水平较低(P<0.05)。结论消水圣愈汤能明显改善老年CPHD患者血栓前状态,减轻炎症反应,促进心功能恢复,临床疗效显著。

薛一涛运用膏方辨治心系疾病思路探析

膏方在治疗慢性疾病方面,具有平调、缓图、长效的特点,薛一涛教授使用膏方治疗心系疾病经验丰富,见解独到,临床上将“辨体-辨病-辨证”与“因时-因人-因地”相结合,灵活考究用药、化裁处方,并以“一脏为主,兼调五脏”为纲,应用膏方防治心系疾病的传变。根据患者的个人体质使用膏方进行调补,可增强体质,不仅能扶正祛邪,对于疾病的并发症也有很好的治疗及预防作用。

基于“结者散之”辨治肺结节痰瘀互结证

肺结节之病机为肺气亏虚,外邪入体,肺之气络、血络先后受邪,气络生痰,血络生瘀,气络之痰与血络之瘀搏结成块,发而为病。从《黄帝内经》“结者散之”理论入手,治以清肺通络、祛痰化瘀为主,佐以疏肝理气,健脾渗湿之法,为肺结节的中医辨证及组方思路提供一定的借鉴与参考。

基于《治肝三十法》探析从肝论治间质性肺疾病咳嗽

清代医家王旭高以肝气、肝火、肝风、肝虚为纲,总结创立了《治肝三十法》。以《治肝三十法》为立足点探析肝气、肝火、肝风、肝虚的源流及内涵,并探讨间质性肺疾病的病机变化与其相似之处,从而提出从肝论治间质性肺疾病咳嗽,分析并探索间质性肺疾病相关咳嗽的临床用药规律及有效方剂,并应用典型案例验证其临床疗效,希望能对中医辨治间质性肺疾病相关咳嗽提供新的思路及方法。

难治性胃食管反流病的原因和中医药诊治策略

胃食管反流病是临床常见病,病理机制复杂,临床症状多样,采用单一治疗方式对部分患者难以奏效,易导致病情迁延而发展成为难治性胃食管反流病。目前国内外对难治性胃食管反流病并无确切的定义和诊断标准,也无统一的治疗方案。中医辨证治疗能够改善患者精神心理状态,提高生命质量,疗效较好。