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Objective:To observe the results of electroacupuncture (EA) on the resuscitation of a rat model of asphyxia cardiac arrest (CA). And to explore its effect on the neurologic deficits and hemodynamic instability of post-cardiac arrest syndrome (PCAS).Methods:A total of 107 male SD rats were randomly divided into sham, CA, and EA groups. Each group received arterial catheterization and tracheal intubation. The sham group was not induced asphyxia. Asphyxial cardiac arrest was established by endotracheal tube clamping. Rats in the CA group received basic respiratory support and fluid resuscitation in return of spontaneous circulation (ROSC) and rats in the EA group received EA at Baihui based on the treatment of CA group after ROSC, with a dense-dispersed wave at frequencies of 4-20 Hz, while the current intensity was adjusted minimum to induce a twitch of the scalp, the course of treatment was 30 minutes. The baseline data, hemodynamics after ROSC, neurological deficit score (NDS), pathological changes of brain tissue, and levels of serum biomarker were recorded and compared among the three groups. The 72-hour survival of rats was analyzed by Kaplan-Meier survival curve. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of necrotic neurons in the hippocampal CA1 region of rat brain. Meanwhile, Nissl staining and TdT-mediated dUTP nick-end labeling (TUNEL) were used to detect cell apoptosis and injury.Results:Compared with the CA group, the mean arterial pressure (MAP) in the EA group increased significantly at 15 minutes after ROSC [mmHg (1 mmHg≈0.133 kPa): 125.00 (94.00, 136.25) vs. 92.00 (72.00, 122.50), P < 0.05]. There was no significant difference in the NDS score between the EA group and the sham group. Still, the NDS score of the rats in the CA group at 6 hours after ROSC were significantly lower than that in the sham group (46.00±10.61 vs. 80.00±0.00, P < 0.05). Kaplan-Meier survival curve analysis showed that EA did not improve the 72-hour survival rate of rats (100% in the sham group, 25% in the CA group, and 30% in the EA group, P > 0.05). The analysis by TUNEL showed that the apoptosis rate of neurons in CA1 region of the hippocampus in EA group at 6 hours after ROSC was significantly lower than that in CA group [(62.84±2.67)% vs. (71.29±3.70)%, P < 0.05]. Compared with the CA group, the level of serum S100 calcium binding protein B (S100B) in the EA group at 6 hours after ROSC was significantly lower (ng/L: 19.30±13.87 vs. 132.28±31.67, P < 0.05), but there were no significant differences in the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) between these two groups. Conclusions:In the present study, EA at Baihui can stabilize the hemodynamic, moreover, it has a particular neuroprotective effect on PCAS rats. Still, EA at Baihui does not reduce the systemic inflammatory response and improve the survival rate of rats, and its mechanism remains to be verified in further research.
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Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.
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Xiyanping injection, a traditional Chinese medicine injection made of andrographolide sulfonate, consisting of well-defined ingredients with antiviral, antibacterial, anti-inflammatory and antipyretic efficacy, has been widely used for treating infectious diseases of respiratory and digestive systems. However, its wide applications may easily lead to unreasonable clinical medication. In order to guide the precise clinical application and rational use of Xiyanping injection, experts in related fields conducted systematically literature review, evaluated and deliberated the application of Xiyanping injection in treating acute infectious diseases using evidence-based medicine method, and jointly drafted the consensus to summarize types of acute infectious diseases in children and adults that can be treated with Xiyanping injection, and recommend the intervention time, usage and dosage, course of treatment and combined medication of the injection. Besides, the consensus elucidates the safety, precautions and contraindications of the injection, so as to provide guidance for clinical use.
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Xiyanping injection, a traditional Chinese medicine injection made of andrographolide sulfonate, consisting of well-defined ingredients with antiviral, antibacterial, anti-inflammatory and antipyretic efficacy, has been widely used for treating infectious diseases of respiratory and digestive systems. However, its wide applications may easily lead to unreasonable clinical medication. In order to guide the precise clinical application and rational use of Xiyanping injection, experts in related fields conducted systematically literature review, evaluated and deliberated the application of Xiyanping injection in treating acute infectious diseases using evidence-based medicine method, and jointly drafted the consensus to summarize types of acute infectious diseases in children and adults that can be treated with Xiyanping injection, and recommend the intervention time, usage and dosage, course of treatment and combined medication of the injection. Besides, the consensus elucidates the safety, precautions and contraindications of the injection, so as to provide guidance for clinical use.
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This paper focuses on the total cerebral ischemic injury after cardiac arrest (CA), the authors analyze how acupuncture improves neurological impairment and the prognosis after CA from the perspectives of traditional Chinese medicine theory and modern research achievements of acupuncture on Shuigou. It should take into consideration of three factors in both basic and clinical study: the time and link of intervention, mechanism, optimization of stimulating parameters in order to clear the direction of acupuncturing Shuigou improves the neural functional recovery after CA.
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This article briefly summarized the meaning, category and function of qi, tubes and viscera in human body respectively after combining exploring the theories of traditional Chinese medicine(TCM) and clinical practices. Afterward, we put forward the theory of Qi-Tube-Viscera and elaborated its close relationship with the physiological status of the human, and then we thought the relationships of qi, tube and viscera respectively, at last we draw a conclusion that qi, tube and viscera only came from qi. And the clinical guiding significance of the theory of Qi-Tube-Viscera and itsBalanced steady state, Nature and Man in One, State medicine were narrated to demonstrate that new theory of Qi-Tube-Viscera has high signifance in the theory of TCM and clinical practice.
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Acute aortic dissection (AAD) is a cardiovascular critical serious disease, and the clinical manifestations of AAD are diverse and complicated. The emergent early diagnosis is often challenging, and misdiagnosis or delay in diagnosis may result in serious consequences. The process of diagnosis and treatment of a patient with Stanford A type AAD firstly manifesting atypical signs and symptoms of osphyalgia and paraplegia was retrospectively analyzed. The related literatures were reviewed to discuss the early diagnostic strategies used in this atypical emergent patient with AAD.
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Objective To Pulse oximetry saturation has been wildly used clinically.It has been reported that pulse oximetry plethysmographic waveform (POP) reflected the peripheral tissue perfusion.In this study,we parameterized POP,observed the value of POP parameters in normal adults,and established the normal reference value range.Methods A multi-center prospective descriptive study.Total of 1 019 adult volunteers with normovolemia from 7 cities were enrolled in this study.Sex,age,height,weight and pulse oximetry data in awake and spontaneous breathing under in quiet conditions in the room temperature were collected.POP parameters and perfusion index were analyzed using MATLAB 2012a software.The normal reference value ranges of POP parameters,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),were formulated.Results Statistical differences of POP parameters were detected between men and women in the normal adult.The 95％ confidence reference value of POP parameters in normal population was as follows:Amp (104.8-2298.7) PVA and AUC (3265.8-6028.5) PVPGin total,Amp (129.4-2433.6) PVA and AUC (3319.0-5862.2) PVPG in male;Amp (89.5-2138.2) PVA and AUC (3163.9-5929.9) PVPG in female.Conclusions POP,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),had normal reference value ranges in normal adults.
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ObjectiveIn order to provide reliable sufficient information for making a policy to develop Emergency Departments in Chinese Medical Hospitals, a countrywide investigation on current situations of such departments was carried out.Methods Firstly, questionnaires which could be responded by filling out on line and paper were made respectively. The Departments of Emergency in 300 Chinese Medical Hospitals widely distributed in 27 provinces of China (municipalities directly under the central government) with technique level 2 or above were observed in this study by Red Cap database or Email.Results All together 280 questionnaires were sent out, and 200 questionnaires were responded. The information from 200 emergency departments of Chinese medical hospitals in 24 provinces was collected, the recovery rate being 71.42%. The investigative results were as follows: ① All Chinese medical hospitals involved in this study were equipped with an independent emergency department. The average occupation of ground area, numbers of ward beds and ambulances in these emergency departments were 713.6 m2, 18.93 and 2.81 respectively, and 75.8% of the hospitals were of the first aid local network units.② There were 26 emergency departments having internal, surgical, women and children emergency clinics, 83 hospitals had internal and surgical emergency clinics only, and in 91 hospitals there was no any special clinic in emergency department. In addition, only did 81 hospitals have intensive care units (ICU).③ The number of clinicians was 11.86±9.28 on average, and 26 hospitals even had no emergency specialists. In 39 hospitals, there were no emergency clinicians with high rank title, most of these clinicians had bachelor or master's degree, and only did 30 hospitals have emergency clinicians with PhD degree.④ The annual average patient admitted in emergency departments of these hospitals was 2.36 thousand cases, including 1197.38 rescue ones. The clinicians who could accomplish abdominocentesis and thoracentesis independently were accounting for 90.7% and 89.0%, respectively, 8.2% hospitals could carry out percutaneous coronary intervention (PCI), and more than 70% hospitals already had the emergency green channel.⑤ About 93.5% hospitals had established a management system of medical quality control, and 89.0% hospitals had already had a medical quality control group.⑥ 65.5% hospitals had assessment index of Utilization rate of traditional Chinese Medicine, and 52.5%hospitals routinely conducted discussions on cases treated primarily by Chinese medicine (CM).Conclusions The development levels of emergency departments of all Chinese medical hospitals involved are very uneven, on which more attention should be paid. The enhanced investment is required to construct the emergency clinics and improve medical techniques in order to meet the growing need of the first aid in our society.
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Objective To investigate the general information and death causes in the emergency department ( ED) with an epidemiological study in the death cases.Methods The clinical records of 1007 death cases in the ED admitted in three years from 2011 to 2013 were collected and statistically analyzed.Methods The clinical records of 1 007 death cases in the ED admitted in three years from 2011 to 2013 were collected and statistically analyzed.Results The mean age of the 1 007 deaths was ( 75.95 ±13.89 ) ears, and the mean score of APACHEⅡ at admission was ( 27.19 ±6.44 ) .Malignant neoplasm, pulmonary infection, chronic obstructive pulmonary disease, coronary heart disease, stroke, sepsis, acute coronary syndromes were main underlying causes of death, while respiratory failure, circulatory collapse, generalized debility, multiple organ dysfunction syndrome, emaciation from malignant neoplasm, septic shock, severe pulmonary infection were main direct lethal causes of death.Most patients were vulnerable to be dead in the spring season, January and around midnight from 23: 00 to 1: 00 (zi time).It is noteworthy that pulmonary infection accounted for 74.75%(151/202 ) of the nosocomial infection. Hyperlactacidemia and low oxygenation index indicated a poor prognosis.Conclusions The deaths were predominant in old age, and the order of incidence of the underlying death causes from high to low arranged was consistent with the sequence of death causes of the cities in China in 2010.To identify carefully the risk factors of death and concern about the early symptoms of exacerbation of underlying diseases can make a big difference in enhancing the success rate of rescuing the critical emergency patients.Besides, it's worth pondering over that the medical care of patients with malignant neoplasm spent abundant emergency resources.
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Objective To analyze patients with acute chest pain as their chief complaint in order to improve our capability of early identifying and diagnosing high-risk patients,give them proper treatment in time and avoid misdiagnosis and improper treatment. Methods The clinical data of 813 patients with chest pain as their chief complaint admitted in the emergency department and critical care medicine department in Guangdong Provincial Traditional Chinese Medicine Hospital from January to December in 2011 were retrospectively analyzed. According to the process of diagnosis and treatment formulated by the chest pain center,all the patients must immediately finish the first electrocardiograph(EEC)examination in 10 minutes and the relevant blood biochemical examinations within 30 minutes after admission. Results In accordance with the relevant examinations,the confirmed diagnoses were as follows:there were 276 cases of unstable angina,accounting for 33.95%;145 cases of stable angina,17.84%;121 cases of acute myocardial infarction,14.88%;103 cases of respiratory system disease,12.67%;78 cases of skeletal muscle disease,9.59%;46 cases of the digestive system disease,5.66% and the high-risk non cardiac chest pain(such as aortic dissection/rupture of tumor or acute pulmonary embolism)12 cases,1.48%.Seven hundred and eighty-five patients finished the first EEC examination in 10 minutes,and 147 patients completed the chest computed tomography(CT)scan within an hour. Conclusions Acute chest pain is a common symptom in emergency department. It is necessary to identify the high-risk patients according to a process as soon as possible in order to get an accurate diagnosis and an effective treatment in time.
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Objective To investigate the relationship between UCG changes and syndrome-types of chest stuffiness and pains (CSP). Methods All 305 cases were diagnosed as CSP and received coronary angiography and echocardiography (UCG). The relationship between UCG changes and syndrome-types of TCM was analyzed. Results When coronary arteries were normal and with no abnormal ventricular wall movemoment,the proportions of blood-stasis syndrome (BSS) group and phlegm-turbid syndrome (PTS) group were lower,while higher in the condition of coronary arteries strait and with abnormal ventricular wall movemoment. BSS and PTS were significantly higher in the group with coronary arteries strait and abnormal diastolic function of left ventricle than in the group with no coronary arteries strait. There was no significantlly different symdrome-types distributing between normal and abnormal left ventricle systolic function group. EF was lower in Qi-stagnation syndrome (QSS) group than non-QSS group. FS was lower in Yang-deficiency syndrome (YDS) group than in non-YDS group,the same condition in PTS group and non-PTS group. Conclusion There was no significantly value of dignosing syndrome-types of chest stuffiness and pains in the use of UCG.
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[Objective] To re-evaluate the diagnostic value of electrocardiogram (ECG) for coronary heart disease (CHD) by coronary arteriogram (CAG). [Methods] ECG and CAG in 375 cases preliminarily diagnosed as having CHD were analyzed. [Results] ECG was abnormal in 252 cases and normal in 123 cases; 278 cases were diagnosed as having CHD and 97 non-CHD by CAG. CHD was confirmed in 205 cases from 252 with abnormal ECG and in 73 cases from 123 with normal ECG. The sensitivity of ECG for CHD was 73.7% and the specificity was 51.5% , indicating that the changes of ECG having different diagnostic value for CHD (P
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Objective To observe the effect of Tongmai Capsules(TC) on high-sensitivity C-reactive protein(hs-CRP) in acute coronary syndrome(ACS) patients.Methods Fifty-four ACS patients were randomized into the treatment group(N=26) and the control group(N=28).The two groups were given routine treatment for coronary heart disease and the complications.Additionally,the control group was given the placebo,and the treatment group was given TC,the treatment lasting one month.The change of the symptom scores was observed before and after treatment,and the hs-CRP level at the admission day,on the 7th day of treatment and after treatment for one month was also detected.Results(1) The score of symptoms of ACS was improved to various degrees in both groups(P0.05) while was decreased in the treatment group(P
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Objective To observe the different effect of Xuezhikang Capsule on the patients of coronary heart disease (CHD) with abnormal blood lipid in different syndromes.Methods Of the 116 patients of CHD with abnormal blood lipid diagnosed by coronary arteriography and blood test, 30 were blood stasis syndrome, 23 phlegm turbid syndrome, 26 phlegm retention syndrome, and 37 non-phlegm non-stasis syndrome. Based on the standard treatment with modern medicine, Xuezhikang Capsule was given 0.6g each time, twice a day, for 24 weeks in succession.Results After the treatment, total cholesterol (TC), triglyceride (TG) and low density lipoprotein-C (LDL-C) were decreased (P