Clinical Experience in the Use of Shaoyao Gouteng Muer Tang

Dr. Men Chunde (门纯德), a late famous TCM expert of Shanxi Province, had engaged in clinical practice for more than 50 years, with rich and precious clinical experiences left for the later generations.

Risk factors for accidental falls in the elderly and intervention strategy

As the population ages, older people's health and quality of life are becoming a matter of public concern increasingly. Through review of the literatures and analysis of the reasons for falls in older people, we worked out some measures to cope with such a situation, provided the self-care knowledge of falls prevention for older people and improved the quality life of older persons. The recovery process is long, if the old people fall down, which brings a lot of inconvenience to individuals and families, and it can also cause a lot of complications. If wary of fall risk factors, the quality of life of older persons can be improved. According to the different conditions of the elderly, we should take effective measures to create suitable living environment for senior citizens, and propagandize the knowledge of the old people's health care, which has the great significance in preventing the elderly's fall, and improving their living quality.

Decreased Average Albumin-to-Globulin Ratio During Radiotherapy Worsens the Prognosis of Esophageal Squamous Cell Carcinoma:Implications for Nutritional Management

Objective Malnutrition and cachexia are common in esophageal squamous cell carcinoma(ESCC)patients undergoing radiotherapy.This study evaluated how malnutrition-and cachexia-related indicators,including the albumin-to-globulin ratio(AGR),and their changes during radiotherapy predict the treatment outcomes.Methods We reviewed a total of 172 ESCC patients receiving radiotherapy(as a primary cohort)and performed a Cox regression analysis on potential prognostic factors,including the AGR,as well as the TNM stage and concomitant chemotherapy.A subsequent receiver operating characteristics(ROC)curve and Kaplan Meier survival analysis was performed for ESCC patients stratified by the average AGR cut-off point.Results In addition to the well-documented factors(i.e.TNM stage and concomitant chemotherapy),the average AGR was a significant prognostic factor for ESCC patients receiving radiotherapy.By plotting the ROC curve of the average AGR with regard to the ESCC prognosis,we obtained cut-off points for the overall patients(cut-off point:1.5,AUC:0.636),for patients with stageⅡ/Ⅲdisease(cut-off point:1.5,AUC:0.611),and for patients with stageⅣdisease(cut-off point:1.84,AUC:0.900).The ESCC patients with higher average AGR had a significantly more favorable OS compared with those with a lower average AGR.Notably,ESCC patients who had an increasingΔAGR during radiotherapy had a considerably more favorable OS compared with those with a decreasingΔAGR.All of these findings were reproducible in the validation cohort.Conclusion A lower average AGR is indicative of a poorer prognosis for ESCC patients following radiotherapy.Improving the nutritional status and preventing or ameliorating cachexia might contribute to improving the prognosis of ESCC patients.

Health care exploration work for the military empty nest old cadres

In recent years, the retired veteran cadres have grown older and older, and their numbers have also increased year by year. In this case, how to maintain the physical and mental health of empty nest veteran cadre, and further improve the quality of their life has been a realistic problem many primary health care doctors have to face and solve.

The Addiction Profiles of Substance Users with Comorbid Attention Deficit-Hyperactivity Disorder: The Comparison with Substance Users without Comorbid Attention Deficit-Hyperactivity Disorder

Objective: The aim of this study is to compare the addiction profiles of substance users with comorbid attention deficit-hyperactivity disorder (ADHD) and of those without attention-deficit hyper-activity disorder (ADHD) comorbidity. Method: 100 patients with substance use disorder (SUD) who continued to undergo inpatient treatment during September 2014-August 2015 in Private Balikli Rum Hospital were included in the study. Based on DSM-5 diagnostic criteria, 50 patients who have SUD with ADHD comorbidity were considered as study group, the other 50 patients with only SUD were evaluated as control group. Sociodemographic Data Form, Buss-Perry Aggression Questionnaire (BPAQ), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Addiction Profile Index (BAPI), and Adult ADHD Self-Report Scale (ASRS ADHD) were given to the patients who participated to the study. Results: It was found that the age of onset for substance use was younger in a statistically significant manner in the patients who had SUD with comorbid ADHD (ADHD-SUD group) than the control group (SUD group) (t = 3.57, p = 0.001). Regarding to scores in the scales of these two groups, scores of aggression questionnaire (BPAQ) and craving subscale (BAPI) in ADHD-SUD group were significantly higher comparing to SUD group. Conclusion: In this study, it was revealed that the age of onset for substance use was younger in substance users with comorbid ADHD and that the level of aggression and craving was higher again in this group. Craving and level of aggression might have negative impacts on the treatment process. Therefore, we believe that it is essential to consider ADHD comorbidity in patients with substance use disorders.

AN ANALYSIS ON THE ACCIDENT OF PNEUMOTHORAX INDUCED BY INCORRECT ACUPUNCTURE TREATMENT

Acupuncture induced pneumothorax is a rarely seen clinical accident. In the present paper, the authors analyze its causes of onset, clinical manifestations and measures for prevention and management.

Shrinking Lung Detected on Computed Tomography:Pictorial Essay of the Main Findings of the Image

Shrinking lung refers to a rare complication of systemic lupus erythematosus and is characterized by unexplained dyspnea, a restrictive pattern in lung function tests, and elevation of the diaphragmatic hemicuples. It is postulated to have a predilection for female involvement and occurs mainly during late stages of the disease. Chest X-rays usually show small, diaphragmatic lungs. Occasional basal atelectasis may be present. Chest tomography usually shows reduced lung volumes with diaphragmatic elevation, occasional basal atelectasis, without severe pulmonary or pleuropulmonary disease. Shrinking lung can cause significant morbidity and occasional mortality. There is no definitive therapy, while corticosteroids may decrease symptoms and improve lung function in some patients. The objective of this study was to describe the main imaging findings in Shrinking Lung, an important pulmonary alteration in lupus patients. We highlight the characteristics observed on radiography and computed tomography, with an emphasis on computed tomography. It is important that every radiologist is prepared to recognize these findings and understand the possible clinical repercussions.

Measurement of the exercising blood flow during rhythmical muscle contractions assessed by Doppler ultrasound:Methodological considerations

Given the recent technological developments, ultra-sound Doppler can provide valuable measurements of arterial blood flow with high temporal resolution. In a clinical setting, measurements of hemodynamics is used to monitor, diagnose and manage changes in blood velocity profile for cardiac valve disease, relatively large vessel stenosis and other cardiovascular diseases. In health science and preventive medicine for cardiovascular disease with exercise therapy, evaluation of cardiac and vascular function is a useful indicator not only at rest but also during exercise, leading to improved exercise tolerance as well as physical activity. During exercise, the increase in oxygen uptake (calculated as product of arterial blood flow to the exercising limb and the arteriovenous oxygen difference) is directly proportional to the work performed. The increased oxygen demand is met through a central mechanism, an increase in cardiac output and blood pressure, as well as a peripheral mechanism, an increase in vascular conductance and oxygen extraction (major part in the whole exercising muscles) from the blood. Therefore, the determination of the local blood flow dynamics (potential oxygen supply) feeding to rhythmic muscle contractions can contribute to the understanding of the factors limiting the work capacity including, for instance the muscle metabolism, substance utilization and vasodilatation in the exercising muscle. Using non-invasive measures of pulsed Doppler ultrasound the validity of evaluating blood velocity/flow in the fore- arm or lower limb conduit artery feeding to the mus- cle is demonstrated during rhythmic muscle exercise;however the exercising blood velocity profile (fast Fourier transformation) due to muscle contractions is always seen as a physiological variability or fluctuations in the magnitude in blood velocity due to the spontaneous muscle contraction and relaxation induced changes in force curve intensity. Considering the above mentioned variation in blood velocity in relation to muscle contractions may provide valuable information for evaluating the blood flow dynamics during exercise. This review presents the methodological concept that underlines the methodological considerations for determining the exercising blood velocity/flow in the limb conduit artery in relation the exercise model of dynamic leg exercise assessed by pulsed Doppler ultrasonography.

An experimental research of Weining granule in treating gastric precancerous lesions

Objective： To investigate potential therapeutic effects and mechanism of Weining granule in the treatment of gastric precancerous lesions. Methods： Sixty rats were randomly assigned to a blank group or a model group or to receive retinoic acid or high-, medium- or low- dose of Weining granule. General conditions of the animals were observed before and after treatment. Changes in gastric mucosal pathohistology, telomerase activity, proliferation index （PI） and apoptosis index （AI） were measured. Results： General conditions, including activity and eating, were improved in all Weining-granule-treated groups with the numbers of rats having intestinal metaplasia （IM）, atypical hyperplasia （ATP） or positive telomerase activity being significantly lower than those in the model group （P 〈 0.05 or P 〈 0.01）. Compared with the model group, all doses of Weining granule significantly decreased PI （P 〈 0.01） and increased AI （P 〈 0.05）. Conclusion： Weining granule may provide a therapeutic benefit for the treatment of gastric precancerous lesions by inhibiting telomerase activity and proliferation of gastric cancer cells and by accelerating their apoptosis.

A new fluorescent particle prepared by chemical stabilized phycobilisome

Natural phycobilisomes （PBSs） were isolated and purified from a red macroalga, Polysiphonia urceolata, by multi-step of sucrose gradient centrifugation, and were chemically stabilized by small molecule cross-linker formaldehyde. The stabilized PBSs showed similar absorption and fluorescent properties at room temperature compared to natural PBSs and kept a steady F672/F580 value during more than 3 months of storage in 0.45 mol/L phosphate buffer （pH 6.8） or at low temperature at 77 K. The stabilized PBS migrated as a single band at mild PAGE and in 14-18 h of sucrose gradient centrifugation. All these characters indicated that the stabilized PBSs were stable, soluble, homogenous fluorescent particles with favorable spectroscopic features prepared under present conditions.

Assessment of voluntary rhythmic muscle contraction-induced exercising blood flow variability measured by Doppler ultrasound

Given recent technological developments, ultrasound Doppler can provide valuable measurements of blood velocity/flow in the conduit artery with high temporal resolution. In human-applied science such as exercise physiology, hemodynamic measurements in the conduit artery is commonly performed by blood flow feeding the exercising muscle, as the increase in oxygen uptake (calculated as a product of arterial blood flow to the exercising limb and the arterio-venous oxygen difference) is directly proportional to the work performed. The increased oxygen demand with physical activity is met through a central mechanism, an increase in cardiac output and blood pressure, as well as a peripheral mechanism, an increase in vascular conductance and oxygen extraction (a major part of the whole exercising muscles) from the blood. The increase in exercising muscle blood flow in relation to the target workload (quantitative response) may be one indicator in circulatory adjustment for the ac- tivity of muscle metabolism. Therefore, the determination of local blood flow dynamics (potential oxygen supply) feeding repeated (rhythmic) muscle contractions can contribute to the understanding of the factors limiting work capacity including, for instance, muscle metabolism, substance utilization and magnitude of vasodilatation in the exercising muscle. Using non-invasive measures of pulsed Doppler ultrasound, the validity of blood velocity/flow in the forearm or lower limb conduit artery feeding to the muscle has been previously demonstrated during rhythmic muscle exercise. For the evaluation of exercising blood flow, not only muscle contraction induced internal physiological variability, or fluctuations in the magnitude of blood velocity due to spontaneous muscle contraction and relaxation induced changes in force curve intensity, superimposed in cardiac beat-by-beat, but also the alterations in the blood velocity (external variability) due to a temporary sudden change in the achieved workload, compared to the target workload, should be considered. Furthermore, a small amount of inconsistency in the voluntary muscle contraction force at each kick seems to be unavoidable, and may influence exercising muscle blood flow, although subjects attempt to perform precisely similar repeated voluntary muscle contractions at target workload (muscle contraction force). This review presents the methodological considerations for the variability of exercising blood velocity/flow in the limb conduit artery during dynamic leg exercise assessed by pulsed Doppler ultrasound in relation to data previously reported in original research.

Health care of elderly military veteran cadres

With the development of our economy and the improvement of people's living standard, the person's life span has been greatly prolonged. Accordingly, there are more and more requirements on health care. The retired cadres in military sanatoriums are heroes in the revolution of our country, and are treasures to our country. However, with the increase of their age, various kinds of diseases have become the main problem bothering the cadres. At present, our party and government are very concerned about veteran cadres. Hence, the medical workers are facing a new problem and challenge as to how to prevent the diseases and improve the medical treatment, and health care for military veteran cadres. We insist on "the people-oriented service and treatment" and try hard to improve service on "prevention, medical care, rehabilitation, and health care". In this way, they may suffer from less pain of diseases, have better prognosis, enjoy happier life, and their disease prevalence and mortality may be lower.

Diagnosis and pharmacologic management of neuropathic pain among patients with chronic low back pain

Chronic low back pain consists of both nociceptive and neuropathic mechanisms and can be classified as a mixed pain syndrome. Neuropathic component of chronic low back pain has often been under-recognized and under-treated by the physicians. Recent studies have demonstrated that approximately 20%-55% of chronic low back pain patients have neuropathic pain symptoms. An altered peripheral, spinal, and supraspinal processing of pain arising as a result of a lesion affecting the nerves system are the major contributor to neuropathic low back pain. The clinical evaluation is still the gold standard for assessment and diagnosis of neuropathic low back pain. Although diagnosis can be difficult due to the lack of reliable gold standard diagnostic test for neuropathic low back pain, screening tools may help non-specialists, in particular, to identify potential patients with neuropathic low back pain who require further diagnostic evaluation and pain management. Several screening tools for neuropathic pain have been developed and tested with different patient populations. Among the screening tools, the pain DETECT questionnaire and the Standardized Evaluation of Pain are validated in patients with low back pain. The Standardized Evaluation of Pain may lead to more effectivein discriminating between neuropathic and nociceptive pain in patients with low back pain according to the higher rate of sensitivity and its validity in patients with low back pain. However, the most appropriate approach is still to combine findings on physical and neurologic examinations and patient's report in distinguishing neuropathic pain from nociceptive pain. The clinical examination including bedside sensory tests is still the best available tool for assessment and diagnosis neuropathic pain among patients with chronic low back pain. Due to the fact that chronic low back pain consists of both nociceptive and neuropathic mechanisms, a multimodal treatment approach is more rational in the management of patients with chronic low back pain. Therefore, combination therapy including drugs with different mechanisms of action should be given to the patients with chronic low back pain.

A Descriptive Review of Epidemiology of COVID-19 in Smokers

Background: COVID-19 is an ongoing global pandemic with paucity of the understanding of the natural history of the disease and how it affects smokers. We aim to study the outcomes of COVID-19 in smokers in this descriptive review. Coronavirus disease 2019 caused by severe acute respiratory syndrome Coronavirus 2, gains entry to bronchial epithelial cells by attachment of the viral spike protein to Angiotensin-Converting Enzyme-2 (ACE-2) receptors. Accordingly, this review aims to understand the associated risk and worsen disease in relation to smoking and explore conflicting information regarding nicotine as well as its potential protective role. Methods: We conducted a non-systematic review of databases with search engines such as, PubMed, Google Scholar with keywords like “COVID-19,” “SARS-CoV-2,” “novel coronavirus,” smoking,” “smokers,” “nicotine.” It included English articles related to the epidemiology of COVID-19 in adult smokers, containing systematic reviews, meta-analysis, prospective and retrospective cohort studies, cross-sectional studies, case series, and case reports based on the relevance of titles and abstracts to the topic. Results: A total of 33 articles were reviewed. Smokers were 1.4 times more likely to have severe COVID-19 (RR = 1.4, 95% CI: 0.98 - 2.00), and 2.4 times more likely to require an ICU admission (RR = 2.4, CI: 1.43 - 4.04) when compared to non-smokers (n = 926). Current smokers were less likely to experience an adverse outcome (OR: 0.42, 95% CI: 0.24 - 0.74), compared to former smokers. 22% of current smokers and 46% of former smokers had more severe complications compared to non-smokers with COVID-19 infection. Current smokers had a case fatality rate of 38.5% (n = 1790). They had higher odds of mortality compared to non-smokers (OR = 1.25), especially males > 65 years age (OR = 2.51). Tobacco smoke upregulates inflammatory cytokines like TNF-α, IL-1β, and neutrophils by activating NF-k. Hence, it leads to increased epithelial cell permeability, mucus production, and impaired mucociliary clearance. The pro-inflammatory action of tobacco smoke impairs the basal laminar cells and causes endothelial dysfunction of the BBB and blood vessels, which leads to neurological, cerebrovascular, and thrombotic complications. Conclusion: Smoking is associated with worse outcomes and mortality in COVID-19. Public education about smoking cessation should be implemented along with standard guidelines to prevent disease progression in this susceptible population.

Cryopreserved fat: our clinical experience and applications

Aim:Cryopreservation of fat is an effective method for repeat fat grafting,but there are few reports about the clinical use of cryopreserved fat.The aim of this study was to determine the effectiveness and safety of cryopreserved fat for clinical use.Methods:Between Aug 2015 and Dec 2018,we investigated 590 patients who underwent fat harvesting at our clinic.The harvested fat was cryopreserved at a temperature of-196°C at a cell processing center and injections were performed in our clinic.Results:Of the 590 patients studied,216(312 cases)have undergone fat injections so far.Volume augmentations using harvested fat,such as facial and breast augmentations,were performed on 180 patients.For 84 patients,harvested fat was utilized only for revitalization/fertilization purposes,such as to improve skin condition.There were no severe complications in any patients.However,volume maintenance was rarely observed.Skin rejuvenation effects were comparable to that in cases using fresh fat.Conclusion:The clinical use of cryopreserved fat is thought to be safe and effective.

新型完全生物可吸收封堵器经导管封堵膜周部室间隔缺损:一项多中心前瞻性随机对照研究

生物可吸收封堵器的应用有望降低传统金属封堵器并发症的风险.之前研制的生物可吸收封堵器存在不完全降解的局限性并导致新的并发症,因此目前尚未有相关产品获批上市.本研究使用了一种新型完全可吸收封堵器,旨在探索完全可吸收封堵器治疗室间隔缺损的疗效和安全性.从2019年4月到2020年1月,本研究在七个医学中心入组125名膜周部室间隔缺损患者,经筛查后108名患者被纳入研究并随机分为植入生物可吸收封堵器实验组和金属封堵器组.所有受试者均成功植入封堵器并完成24个月的随访.生物可吸收封堵器组患者经胸超声心动图显示高亮回声在24个月内逐渐消失,说明可吸收封堵器在体内实现完全降解.对比金属封堵器,实验组器械相关心律失常发生率(5.56%vs.14.81%,P=0.112)和持续传导阻滞发生率(0/54 vs.6/54,P=0.036)显著降低.本研究提示新型完全可吸收封堵器可以在单纯超声引导下实现成功植入,同时降低术后永久性心律失常的发生率.

Treatment of 36 Cases of Infantile Enuresis by Acupuncture

Treated 36 cases of infantile enuresis by acupuncturing Zuyunganqu (Foot Motor Sensory Area) Guanyuan (CV 4), Qihai (CV 6), Zhongwan (CV 12), Zusanli (ST 36), Yinlingquan (SP 9), Pishu (BL 20), Weishu (BL 21) and Shenshu (BL 23). After two courses, 29 cases were cured, 5 cases were improvement and 2cases were no effect. Key Words Enuresis - Scalp Acupuncture - Acupuncture Therapy - Child

Neuroinflammation and neurological alterations in chronic liver diseases

Several million people with chronic liver diseases(cirrhosis,hepatitis)show neurological alterations,named hepatic encephalopathy(HE)with cognitive and motor alterations that impair quality of life and reduces life span.Inflammation acts synergistically with hyperammonemia to induce cognitive and motor alterations in patients with chronic liver disease and minimal hepatic encephalopathy(MHE).Previous studies in animal models have suggested that neuroinflammation is a major player in HE.This would also be the case in patients with liver cirrhosis or hepatitis C with HE.Rats with MHE show microglial activation and neuroinflammation that is associated with cognitive impairment and hypokinesia.The anti-inflammatory drug ibuprofen reduces microglial activation and neuroinflammation and restores cognitive and motor functions in rats with MHE.Chronic hyperammonemia per se induces neuroinflammation.Both peripheral inflammation and hyperammonemia would contribute to neuroinflammation in chronic liver failure.Therefore,neuroinflammation may be a key therapeutic target to improve the cognitive and motor alterations in MHE and overt HE.Identifying new targets to reduce neuroinflammation in MHE without inducing secondary effects would serve to develop new therapeutic tools to reverse the cognitive and motor alterations in patients with HE associated with chronic liver diseases.

Effects of financial incentives for treatment supporters on tuberculosis treatment outcomes in Swaziland: a pragmatic interventional study

Background:Swaziland has the highest national incidence of tuberculosis(TB)in the world,with treatment success rates well below the 85%international target.Treatment support as part of comprehensive TB services is a core component of the Stop TB Strategy.This study investigated the effects of financial incentives for treatment supporters on TB treatment outcomes in Swaziland.Methods:This was a controlled study that compared treatment outcomes for patients with a treatment supporter who received or did not receive a financial incentive.Results:The intervention group had a higher chance of treatment success as compared with the control group:73%(95%confidence intervals[CIs]66–80%)versus 60%(95%CIs 57–64%),respectively,p=0.003.This improvement remained significant when treatment success rates were adjusted for differences in baseline characteristics,with the effect of incentivised treatment supporters on treatment outcomes having an odds ratio(OR)of 1.8.There was also a significant improvement in the death rate in the intervention group,as compared with the control group(10.6 versus 23.5%,p=<0.001).Conclusion:Incentives provided to TB treatment supporters appear to significantly improve TB treatment outcomes.Incentivising treatment support may be appropriate as an effective addition to support and supervision measures(199 words).