[SHENG Can-ruo's experience in treatment of goiter with integrated acupuncture and herbal medication].

The paper introduces professor SHENG Can-ruo's experience in treatment of goiter with the combination of acupuncture and herbal medication. Professor SHENG believes that this disease is mostly related with emotional injury, improper diet and geographical and climatic factors, as well as body constitution. Qi stagnation, phlegm retention, blood stagnation and interaction of phlegm and stasis are the essential pathogenesis of goiter. Either acupuncture or herbal medication should focus on "phlegm and stasis" in treatment. Besides, the theory of western medicine should also be considered. In western medicine, thyroid enlargement is classified into Ⅰ, Ⅱ and Ⅲ degrees of struma, thus, the pathogenesis and treatment with Chinese medicine should be adjusted accordingly. The created "four throat points", combined with acupuncture at distal points, relieve the local masses. The basic herbal formula is prepared and the couplet medicines are modified based on syndrome differentiation. The integrated acupuncture and herbal medication regulates emotions and provides a comprehensive treatment for goiter.

The Efficacy of Acupuncture on Tic Disorders in Children: A Retrospective and Propensity Score-Matched Study.

Background : Acupuncture has been considered as a complementary or alternative therapy for children with tic disorders (TD), but its efficacy remains largely unknown. This study retrospectively examined the efficacy of acupuncture treatment for TD in children over the course of 12 weeks. Methods: Data were collected from Traditional Chinese Medicine clinics in a public pediatric hospital in Shanghai between June 2020 and March 2021. A total of 250 patients with TD were included in the study, with 122 patients exposed to acupuncture therapy combined with conventional treatment (observation group), and 128 patients exposed to conventional treatment alone (control group). Propensity score matching analyses were used to balance baseline characteristics, resulting in 78 matched patients for each group. Reductions in the Yale Global Tic Severity Scale (YGTSS) total score were analyzed in the two groups after 12 weeks of treatment. Results: The two groups reached equilibrium in terms of baseline demographic characteristics and YGTSS total score after the propensity score matching (P > 0.05). Compared to the control group, the reduction in the YGTSS total score after 12 weeks of treatment was greater for the observation group (OR = 2.94, 95% CI: 1.03, 8.39, P = 0.04), and this association was stronger for patients who had significant vocal tics (ß = 0.29, 95% CI: 0.88, 2.68, P = 0.001). The clinical efficacy for the observation group was significantly better than the control group. Conclusions: We provided preliminary evidence supporting the therapeutic effect of acupuncture for TD in children. Hence, our findings indicate that acupuncture could be an adjuvant treatment efficacious for TD in children, especially for vocal tics.

[Effects of glutamine combined with ulinastatin on inflammatory response of patients with severe burn injury].

OBJECTIVE: To observe the effects of glutamine combined with ulinastatin on inflammatory response of patients with severe burn injury. METHODS: Sixty patients with severe burn injury admitted to our burn wards from January 2010 to December 2011 conforming to the study criteria were divided into control group (C, n = 20), glutamine group (G, n = 20), and glutamine combined with ulinastatin group (G + U, n = 20) according to the random number table. Another 10 healthy volunteers were chosen as normal control group (NC). Isonitrogenous and isocaloric nutrition supports were given to patients in groups C, G, and G + U from post burn day (PBD) 2. 0.3 g/kg protein in the form of glutamine dipeptide was given to patients in group G for 10 days. 0.3 g/kg protein was given to patients in group G + U for 10 days with the same amount of glutamine dipeptide as that in group G, followed by intravenous injection of 100 kU ulinastatin (once per 8 hours) for 7 days during 10 days. The nitrogen concentration of 24 h urine was determined with Kieldahl nitrogen determination method, and nitrogen balance was calculated one day before treatment and ten days after treatment. Meanwhile, the levels of D-lactate in serum was determined by colorimetric method, the levels of diamine oxidase (DAO), TNF-α, and IL-6 by enzyme-linked immunosorbent assay, and LPS level by kinetic turbidimetric assay with TAL. Above-mentioned indexes were also examined in group NC. The wound healing rate on PBD 30, total hospital stay days, and the incidence of burn sepsis of all burn patients were recorded. Data were processed with one-way analysis of variance, LSD test, t test, and chi-square test. RESULTS: Compared with that in group C [(-5.40 ± 1.67) g/d], nitrogen balance in group G was significantly increased ten days after treatment [(-1.35 ± 0.59) g/d, P < 0.01]. The serum levels of D-lactate, DAO, LPS, TNF-α, and IL-6 in group G ten days after treatment were significantly lower than those in group C (P < 0.05 or P < 0.01). No statistically significant difference was observed in nitrogen balance and the serum levels of D-lactate, DAO between group G + U and group G (P values all above 0.05). The serum levels of LPS, TNF-α, and IL-6 in group G + U ten days after treatment were respectively (0.167 ± 0.064) EU/mL, (43 ± 14) pg/mL, (139 ± 23) pg/mL, which were significantly lower than those in group G [(0.240 ± 0.079) EU/mL, (59 ± 8) pg/mL, (195 ± 31) pg/mL, respectively, P < 0.05 or P < 0.01]. The would healing rate on PBD 30 and total hospital stay days in group G were respectively higher and shorter than those in group C (P values all below 0.01), but no statistically significant difference in the incidence of burn sepsis was found between them (P > 0.05). The would healing rate on PBD 30 in group G+U [(96 ± 4)%] was enhanced, and total hospital stay days [(41 ± 4) d] were lowered than those in group G [(88 ± 7)%, (49 ± 5)d, P values all below 0.01]. The incidence of burn sepsis of patients in group G + U (5%) was significantly lower than that in group C (35%, χ(2) = 6.234, P < 0.05). CONCLUSIONS: Glutamine combined with ulinastatin treatment can alleviate damage to intestine after severe burn injury, lower the serum level of inflammatory cytokines, promote wound healing, and reduce the incidence of burn sepsis.

[Value of serum ferritin in measuring the activation and prognosis in systemic onset juvenile idiopathic arthritis].

OBJECTIVE: To explore the correlation of serum ferritin (SF) and systemic onset juvenile idiopathic arthritis (SOJIA) so as to determine the prognostic values of SF for SOJIA. METHODS: All samples were collected from 92 juvenile idiopathic arthritis (JIA) patients at Beijing Children's Hospital between February 2005 to September 2012. Their age range was 2-15 years. There were macrophage activation syndrome (MAS, n = 25), polyarticular JIA (n = 33) and oligoarticular JIA (n = 30). And 47 healthy children and another 30 with acute infective diseases were selected as control groups respectively. Blood samples were collected and SF was measured in different disease phases.Other parameters include leucocyte, hemoglobin, platelet, C-reactive protein and erythrocyte sedimentation rate.Statistics of SF level at different groups as well as at different disease phases were performed. RESULTS: The SF level of active phase SOJIA patients was significantly higher (P < 0.01) than that in Other groups. And its level in the active phase of SOJIA was significantly higher than that in patients during the recovery phase. The SF level in patients with MAS was significantly higher than that in those without MAS. CONCLUSION: Correlated with the course of SOJIA, the level of SF may judge the disease activity and predict the outcomes of SOJIA.

[Clinical efficacy of mycophenolate mofetil in the treatment of systemic-onset juvenile idiopathic arthritis].

OBJECTIVE: To evaluate the clinical efficacy of mycophenolate mofetil (MMF) in the treatment of systemic-onset juvenile idiopathic arthritis (SoJIA). METHODS: Thirty-five patients with a confirmed diagnosis of SoJIA who had received initial treatment were randomly divided into control (n=15), MMF1 (n=7) and MMF2 groups (n=13). The control group received conventional treatment, the MMF1 group received MMF after 2 weeks of conventional treatment that had not led to remission, and the MMF2 group received combination therapy with non-steroidal anti-inflammatory drugs, prednisone and MMF. Symptoms, signs, laboratory indices, and adverse events were observed after 2, 4, and 12 weeks of treatment, and follow-up was performed for 3-6 months. RESULTS: Before treatment, the MMF2 group had a significantly longer disease course than the control group (P<0.05). After 2 weeks of treatment, the MMF1 and MMF2 groups had a significantly lower prednisone dose and erythrocyte sedimentation rate (ESR) than the control group (P<0.05). The MMF1 group had significantly higher body temperature than the other two groups (P<0.05). After 4 weeks of treatment, the MMF1 group had a significantly lower prednisone dose and ESR than the control group (P<0.05). The MMF2 group had a significantly lower prednisone dose, body temperature (recovery to normal), white blood cell count, ESR and serum ferritin concentration than the control group (P<0.05). Body temperature was significantly lower in the MMF2 group than in the MMF1 group (P<0.05). No adverse events were observed in either the MMF1 or MMF2 groups during treatment. CONCLUSIONS: Combination therapy with MMF can lead to better control of the patient's condition, more rapid relief of clinical symptoms and reduced glucocorticoid dose. The therapy with MMF is safe in children.

[Efficacy of thalidomide for treatment of juvenile idiopathic arthritis].

OBJECTIVE: To evaluate the efficacy of thalidomide in the treatment of juvenile idiopathic arthritis (JIA). METHODS: Twelve children with JIA who did not respond to conventional treatment were administered with thalidomide (2 mg/kg daily). The symptoms, signs, and laboratory test results were compared before and after treatment. The thalidomide-related side effects were observed. RESULTS: The average dosage of prednisone was reduced from 1.92 ± 0.16 mg/kg•d to 0.49 ± 0.42 mg/kg•d in the 12 patients 6 months after thalidomide treatment (P<0.01). Four patients did not need prednisone treatment any more. White blood cell count, erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and serum ferritin (SF) significantly decreased after treatment in all of 12 patients (P<0.01). Hemoglobin level increased to normal in 8 patients after treatment (P<0.01). The number of affected joints decreased from 5 before treatment to zero to 2 after treatment in patients with polyarticular JIA (P<0.01). Signs of hip involvement and Schober's sign turned negative in enthesitis-related cases. No thalidomide-related side effects were observed. CONCLUSIONS: Thalidomide is effective in the treatment of JIA in children who do not respond to conventional treatment.

[Macrophage activation syndrome in Chinese children with systemic onset juvenile idiopathic arthritis].

OBJECTIVE: To review and analyze the clinical features, treatment, and outcome of macrophage activation syndrome (MAS) in children with systemic onset juvennil rheumatoid arthritis (SOJRA). METHOD: Retrospective review and analysis were performed on cases with MAS from a prospectively collected database of children with SOJRA from the year of 2003 to 2006 in the Hospital. RESULTS: Twenty four patients (21 boys, 3 girls) were diagnosed as having MAS with SOJRA. Mean age of the patients with MAS at diagnosis was 7 years, and the duration prior to diagnosis of MAS was 12 months. No trigger factors were found except in one case whose MAS was triggered by use of methotrexate and in another by parvovirus B19 infection. High grade fever, new onset hepatosplenomegaly and lymphadenopathy, pancytopenia, liver dysfunction were common clinical features in all the 24 cases (100%). Bleeding from skin, mucous membrane and gastrointestinal tract were noted in 9 cases (38%). Twelve (50%) cases had CNS dysfunction (high intracranial pressure, seizure and coma). Six cases (25%) developed ARDS. One patient suffered from renal damage. The laboratory test revealed elevated live enzymes and ferritin, decreased value of ESR, albumin, complete blood count and fibrinogen in all the 24 cases. Bone marrow examination supported the diagnosis of definite hemophagocytosis in the 24 cases. Lymph node biopsy was done for one case and histopathological examination showed that the node was full of activated macrophage. As to treatment, five cases only received high dose steroids (three of them died), 14 cases were treated with high dose steroids plus cyclosporine (one died), two were treated with steroids plus cyclosporine and etoposide (none died). The causes of deaths were ARDS and CNS involvement. In three of the cases who died, treatment was given up by their parents. CONCLUSIONS: MAS is a rare and potentially fatal complication of SOJRA. Most of our patients were male. Bone marrow studies support the diagnosis. CNS involvement and ARDS were poor prognostic signs. Early diagnosis and aggressive therapy are essential.