Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction / 中国医学科学杂志(英文版)

Objective To investigate the impact of microvascular obstruction (MVO) on the global and regional myocardial function by cardiac magnetic resonance feature-tracking (CMR-FT) in ST-segment-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention.Methods Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1 - 7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study. Based on the presence or absence of MVO on late gadolinium enhancement images, patients were divided into groups with MVO and without MVO. The infarct zone, adjacent zone, and remote zone were determined based on a myocardial 16-segment model. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) of the global left ventricle (LV) and the infarct, adjacent, and remote zones were measured by CMR-FT from cine images and compared between patients with and without MVO using independent-samples t-test. Logistic regression analysis was used to assess the association of MVO with the impaired LV function.Results A total of 157 STEMI patients (mean age 56.66 ± 11.38 years) were enrolled. MVO was detected in 37.58% (59/157) of STEMI patients, and the mean size of MVO was 3.00 ±3.76 mL. Compared with patients without MVO (n =98 ), the MVO group had significantly reduced LV global RS (t= -4.30, P < 0.001), global CS (t= 4.99, P < 0.001), and global LS ( t= 3.51, P = 0.001). The RS and CS of the infarct zone in patients with MVO were significantly reduced (t= -3.38, P = 0.001; t= 2.64, P = 0.01; respectively) and the infarct size was significantly larger (t= 8.37, P < 0.001) than that of patients without MVO. The presence of LV MVO [OR= 4.10, 95%CI: 2.05 - 8.19, P<0.001) and its size [OR=1.38, 95%CI: 1.10-1.72, P=0.01], along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis, while only heart rate (OR=1.08, 95%CI: 1.03 - 1.13, P=0.001) and LV infarct size (OR=1.10, 95%CI: 1.03 - 1.16, P=0.003) were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.Conclusion The infarct size was larger in STEMI patients with MVO, and MVO deteriorates the global and regional LV myocardial function.

Free PSA performs better than total PSA in predicting prostate volume in Chinese men with PSA levels of 2.5-9.9 ng ml-1 / 亚洲男科学杂志(英文版)

This study investigated whether free prostate-specific antigen (fPSA) performs better than total PSA (tPSA) in predicting prostate volume (PV) in Chinese men with different PSA levels. A total of 5463 men with PSA levels of <10 ng ml-1 and without prostate cancer diagnosis were included in this study. Patients were classified into four groups: PSA <2.5 ng ml-1, 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1. Pearson/Spearman's correlation coefficient (r) and receiver operating characteristic (ROC) curves were used to evaluate the ability of tPSA and fPSA to predict PV. The correlation coefficient between tPSA and PV in the PSA <2.5 ng ml-1 cohort (r = 0.422; P < 0.001) was markedly higher than those of the cohorts with PSA levels of 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1 (r = 0.114, 0.167, and 0.264, respectively; all P ≤ 0.001), while fPSA levels did not differ significantly among different PSA groups. Area under ROC curve (AUC) analyses revealed that the performance of fPSA in predicting PV ≥40 ml (AUC: 0.694, 0.714, and 0.727) was better than that of tPSA (AUC = 0.545, 0.561, and 0.611) in men with PSA levels of 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1, respectively, but not at PSA levels of <2.5 ng ml-1 (AUC: 0.713 vs 0.720). These findings suggest that the relationship between tPSA and PV may vary with PSA level and that fPSA is more powerful at predicting PV only in the ''gray zone'' (PSA levels of 2.5-9.9 ng ml-1), but its performance was similar to that of tPSA at PSA levels of <2.5 ng ml-1.

Effect and Mechanism of "Liver-Soothing and Spleen-Invigorating" Therapies Against Liver Injury in Rats： An Exploration Based on TGR5 and Intestinal Mucosal Barrier Function / 中国实验方剂学杂志

ObjectiveTo explore the effects of different treatment methods of "soothing liver， invigorating spleen， soothing liver and invigorating spleen， soothing liver first and then soothing liver and invigorating spleen， as well as invigorating spleen first and then soothing liver and invigorating spleen" on liver depression combined with liver injury in rats and their action mechanisms. MethodA six-week rat model of liver depression combined with liver injury was established by restraint stress and subcutaneous injection of carbon tetrachloride （CCl4， 5.89 g·kg-1， once every three days）. At the same time， the drugs were given by gavage. Forty-eight male SD rats of clean grade were randomly divided into eight groups， namely the normal group， model group， bicyclol （0.2 g·kg-1） group， Sinisan （4.32 g·kg-1） group， Liu Junzitang （9.26 g·kg-1） group， Chaishao Liu Junzitang A （Chai A， soothing liver and invigorating spleen，13.57 g·kg-1） group， Chaishao Liu Junzitang B （Chai B， soothing liver first and then soothing liver and invigorating spleen， 13.57 g·kg-1） group， and Chaishao Liu Junzitang C （Chai C， invigorating spleen first and then soothing liver and invigorating spleen， 13.57 g·kg-1） group， with six rats in each group. The pathological changes in liver and colon tissues of each group were observed under light microscope and electron microscope. The serum biochemical indexes of the liver were detected using an automatic biochemical analyzer. The relative mRNA expression levels of Takeda G protein-coupled receptor 5 （TGR5） and intestinal mucosal zona occluden-1 （ZO-1）， Occludin， and Claudin-1 in the liver and colon were detected by reverse-transcription polymerase chain reaction （RT-PCR）. The positive expression rate of proliferating cell nuclear antigen （PCNA） in the colon was detected by immunohistochemistry. ResultCompared with normal group， the model group exhibited significantly elevated serum alkaline phosphatase （ALP）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bilirubin （TBIL）， and direct bilirubin （DBIL） （P<0.01）， lowered TGR5 mRNA expression in liver tissue， up-regulated TGR5 mRNA expression in the colon tissue （P<0.05，P<0.01）， and down-regulated ZO-1， Occludin， and tight junction protein-1 (Claudin-1) mRNA expression and PCNA in the colon tissue （P<0.01）. Compared with the model group， bicyclol and Chai C remarkably decreased the levels of serum ALP， ALT， AST， TBIL， and DBIL （P<0.05，P<0.01）， while Liu Junzitang， Chai A， Chai B， and Chai C significantly up-regulated the TGR5 mRNA expression in the liver and down-regulated its expression in the colon （P<0.01）. Bicyclol， Chai A， Chai B， and Chai C enhanced the ZO-1 and Claudin-1 mRNA expression in the colon （P<0.05，P<0.01）. Bicyclol， Sinisan， and Chai C increased PCNA expression （P<0.01）. The comparison with the Chai C group showed that the TGR5 mRNA expression in the liver and ZO-1 mRNA expression in the colon of the bicyclol and Sinisan groups were lower， whereas the TGR5 mRNA expression in the colon was higher （P<0.01）. However， the PCNA expression in the colon of the Liu Junzitang and Chai B groups declined significantly （P<0.05）. ConclusionIn the presence of liver injury， invigorating spleen first helps to relieve the liver injury， and the efficacy of "spleen-invigorating" therapy in increasing the intestinal mucosal tight junction proteins and improving the gastrointestinal function is related to its activation of TGR5 to improve the intestinal mucosal barrier function， promote the renewal of intestinal stem cells， and drive the regeneration after injury.

Reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon in the treatment of chronic lateral ankle instability / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of reconstruction the anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon for the treatment of chronic lateral ankle instability.@*METHODS@#The clinical data of 42 patients with chronic lateral ankle instability treated by anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon from July 2016 to July 2019 was retrospectively analyzed. Including 30 males and 12 females, age ranged from 25 to 46 years old with an average of (37.6±12.4) years. There were 15 cases of left foot and 27 cases of right foot, the time from injury to operation was 3 to 12 months with a mean of (7.4±2.8) months. And 14 patients had tenderness in lateral collateral ligament area, 28 patients complained of multiple ankle sprains while walking on the flat ground. At 12 months after operation, the talar tilt angle and visual analogue scale(VAS)were observed, ankle joint varus stress and anterior drawer test were performed to check the mechanical stability of the ankle joint, American Orhopaedic Foot and Ankle Society(AOFAS) was used to score the ankle and hindfoot functions and evaluate the curative effect.@*RESULTS@#Forty patients were followed up for 12 to 48 months with an average of (28.3±10.0) months, 2 cases were lost. The VAS decreased from(4.50±0.93) scores before surgery to (1.10±0.30) scores at 12 months after surgery;the talar tilt angle was reduced from (12.26±1.13)° before operation to (4.60±0.45)° at 12 months after operation;the AOFAS score increased from (65.10±7.50)scores before surgery to (84.40±3.95) scores at 12 months after surgery;all the differences were statically significant(P<0.05). According to the AOFAS score, 27 cases got excellent results, 7 good, 5 fair, and 1 poor. One patient had the symptoms of sural nerve injury after operation, and the symptoms were relieved after oral Mecobalamin for 3 months. The remaining patients had no complications such as nerve injury, infection, and skin necrosis. There was no instability of ankle joint, and both ankle varus stress test and drawer test were negative.@*CONCLUSION@#Autologous peroneal brevis tendon with double bone channel pass through the tendon (modified Chrisman-Snook operation) can anatomically reconstruct the anterior talofibular ligament and the calcaneofibular ligament, restore the stability of the patient's ankle joint, reduce postoperative complications, and restore ankle joint function well.

Prevalence of CYP2C19 gene mutations in patients with coronary heart disease and its biological activation effect in clopidogrel antiplatelet response / 中华心血管病杂志

Objective: The purpose of this study was to investigate the effects of CYP2C19 gene mutations on clopidogrel antiplatelet activity in the patients with coronary heart disease treated by percutaneous coronary intervention. Methods: Patients with coronary heart disease, who hospitalized in the Second Affiliated Hospital of Nanchang University from March 2011 to June 2019, and healthy individuals with matching genetic background, gender, and age as controls were included in this study. Basic clinical data were analyzed and blood samples of all research subjects were obtained for extraction of DNA, and Sanger first-generation sequencing method was used to detect CYP2C19 gene mutation from full exon and exon and intron junction. CYP2C19 gene variations in patients with coronary heart disease were compared with the 1000 Genomes Browse database and the sequencing results of healthy controls to determine whether the gene variation was a genetic mutation or a genetic polymorphism. After that, PolyPhen-2 prediction software was used to analyze the harmfulness of gene mutations to predict the effect of mutations on protein function. The same dose of CYP2C19 wild-type plasmid and the CYP2C19 gene mutant plasmids were transfected into human normal liver cells HL-7702. After transfection of 24 h, the expression of CYP2C19 protease in each group was detected. The liver S9 protein was incubated with clopidogrel, acted on platelets to detect the platelet aggregation rate and the activity of human vasodilator-activated phosphoprotein (VASP). Results: A total of 1 493 patients with coronary heart disease (59.36%) were enrolled, the average age was (64.5±10.4) years old, of which 1 129 were male (75.62%). Meanwhile, 1 022 healthy physical examination volunteers (40.64%) were enrolled, and the average age was (64.1±11.0) years old, of which 778 were male (76.13%). A total of 5 gene mutations of CYP2C19 gene were identified in 12 patients (0.80%), namely, 4 known mutations T130K (1 case), M136K (6 cases), N277K (3 cases), V472I (1 case) and one new mutation G27V (1 case), no corresponding gene mutation was found in healthy controls. It was found that T130K and M136K were probably damaging, G27V was possibly damaging, and N277K and V472I were benign mutations. In vitro, we demonstrated that the platelet aggregation rate of the M136K gene mutation group was 24.83% lower than that of the wild type (59.58% vs. 34.75%; P<0.05), and the phosphorylated VASP level was 23.0% higher than that of the wild type (1.0 vs. 1.23; P<0.05). However, the platelet aggregation rate and phosphorylated VASP level were similar between of G27V, T130K, N277K, V472I gene mutation groups and wild type group (P>0.05). Conclusions: In this study, 5 gene mutations are defined in patients with coronary heart disease, namely G27V, T130K, M136K, N277K, V472I. In vitro functional studies show that CYP2C19 gene mutation M136K, as a gain-of-function gene mutation, can enhance the activation of CYP2C19 enzyme on clopidogrel, thereby inhibiting the platelet aggregation rate.

Exogenous Local Hyperthermia at 41o C Is Effective to Eliminate Mouse Model of Sporotrichosis, Independent of Neutrophil Extracellular Traps Formation

Background@#Local hyperthermia is recommended for the treatment of patients with fixed cutaneous sporotrichosis, though the effectiveness and mechanisms of action remain elusive. While neutrophils represent the main inflammatory cells associated with sporotrichosis lesions, the issue of whether hyperthermia is involved with interactions between neutrophils and Sporothrix globosa remains unclear. @*Objective@#To evaluate the effect of local hyperthermia on sporotrichosis and determine whether local hyperthermia involves effects of neutrophils against Sporothrix. @*Methods@#For the in vivo study, mice were infected with yeast cells of S. globosa followed by treatment with local hyperthermia. In vitro, an isolated S. globosa strain was co-cultured with or without neutrophils and subjected under different temperatures. Immunofluorescence was used to assess the formation of neutrophil extracellular trap (NETs) were formed under these different culture conditions and the number of fungi colony forming units were compared. Results: Hyperthermia was significantly more effective in clearing the lesions in the mouse model, as compared to sham treatment. Neutrophils failed to exert any fungicidal effects against S. globosa in response to hyperthermia. Moreover, NETs were formed after interactionwith S. globosa, and the percentage of NETs formed was not significantly different at 41o C or 37o C. @*Conclusion@#While hyperthermia could serve as an effective therapy for fixed cutaneous sporotrichosis, this ability does not involve the formation of NETs.

Modified Jiegeng Yuansentang Combined with Conventional Therapy Improves Postoperative Mucosal Edema of Chronic Rhinosinusitis Patients with Nasal Polyps and Its Mechanism of Action / 中国实验方剂学杂志

Objective:To explore the curative effect and mechanism of modified Jiegeng Yuansentang combined with conventional therapy for postoperative mucosal edema in patients with cchronic rhinosinusitis with nasal polyps due to pulmonary Qi stagnation， and to explore its mechanism of action. Method:The 90 patients were randomly divided into control group and observation group， 45 cases in each group.All patients were given conventional therapy after nasal endoscopy.Patients in control group were also given mometasone furoate combined with clarithromycin， and patients in observation group were given modified Jiegeng Yuansentang for internal administration and local irrigation.The course of the treatment was 6 weeks.The sino nasal outcome test-20 （SNOT-20）， nasal situation Lund-Kennedy， rhinoconjunctivitis quality of life questionnaire （RQLQ）， traditional Chinese medicine （TCM） syndrome， serum and nasal secretions inflammatory cytokines ［tumor necrosis factor-alpha （TNF-<italic>α</italic>）， interleukin-1<italic>β</italic> （IL-1<italic>β</italic>）， interleukin-5 （IL-5），interleukin-17 （IL-17）］， serum protein ［aquaporin-1 （AQP-1）， aquaporin-3 （AQP-3）， aquaporin-5 （AQP-5）， fibronectin （Fn）］ were observed before and after treatment in two groups.The clinical symptoms， safety and recurrence after a follow-up of 12 months were compared between two groups. Result:The total effective rate was 97.73% （43/44） in observation group， which was higher than 80.95% （34/42） in control group （<italic>χ</italic>²=4.726， <italic>P</italic><0.05）.The patients were followed up for at least 12 months， and the recurrence rate was 4.65% （2/43） in observation group， which was lower than 32.35% （11/34） in control group （<italic>χ</italic>²=4.129， <italic>P</italic><0.05）.Compared with control group after treatment， the SNOT-20， Lund-Kennedy， RQLQ， TCM syndrome， TNF-<italic>α</italic>， IL-1<italic>β</italic>， IL-5， IL-17， AQP-5 were significantly decreased in observation group （<italic>P</italic><0.05）， while AQP-1， AQP-3， Fn were significantly increased in observation group （<italic>P</italic><0.05）.The incidence of adverse reactions was 2.27% （1/44） in observation group， lower than 57.14% （24/42） in control group （<italic>χ</italic>²=5.243， <italic>P</italic><0.05）. Conclusion:Modified Jiegeng Yuansentang can significantly improve postoperative mucosal edema in patients with chronic rhinosinusitis with nasal polyps due to pulmonary Qi stagnation， and the mechanism may be related to the regulation of inflammatory factors in serum and nasal secretions.

Active components and action mechanism of Shenmai Injection in treatment of atrial fibrillation based on network pharmacology and molecular docking / 中国中药杂志

This study aims to explore the active components and molecular mechanism of Shenmai Injection in the treatment of atrial fibrillation(AF) based on the application of network pharmacology and molecular docking technology. The chemical components of single herbs of Shenmai Injection were collected from TCMSP and TCMID, with the standard chemical name and PubChem CID(referred to as CID) obtained from PubChem database. The active components were screened using SwissADME, and their targets were predicted using SwissTargetPrediction. Targets related to AF treatment were identified using GeneCards, OMIM, and other databases. Venn diagram was constructed using Venny 2.1 to obtain the intersection targets. The single herb-active component-potential target network was constructed using Cytoscape, and the clusterProfiler R function package was used to perform the gene ontology(GO) and Kyoto encyclopedia of genes and genomes(KEGG) pathway enrichment. The protein-protein interaction(PPI) network of intersection targets was generated based on the STRING database. The hub target protein was identified by visualization using Cytoscape, and then docked to its reverse-selected active components. The analysis showed that there were 65 active components with 681 corresponding targets in Shenmai Injection, 2 798 targets related to AF treatment, and 235 intersection targets involving 2 549 GO functions and 153 KEGG pathways. Finally, hub target proteins, including RAC-alpha serine/threonine-protein kinase(AKT1), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha(PIK3 CA), and estrogen receptor 1(ESR1), were screened out by PPI network visualization. The molecular docking was performed for 39 active components screened out in reverse, among which 30 active components de-monstrated high affinity. Among them, homoisoflavanoids CID 10871974, CID 5319742, and CID 10361149 had stronger affinity docking with AKT1. This study preliminarily indicates that Shenmai Injection treats AF through multiple components, multiple targets, and multiple pathways. Homoisoflavonoids of Ophiopogon japonicus are its important active components, which target AKT1 to regulate metabolism, inflammation, and apoptosis in AF treatment.

The new target of Rapamycin: lysosomal calcium channel TRPML1 / 生理学报

Rapamycin (Rap) is an immunosuppressant, which is mainly used in the anti-rejection of organ transplantation. Meanwhile, it also shows great potential in the fields of anticancer, neuroprotection and anti-aging. Rap can inhibit the activity of mammalian target of Rap (mTOR). It activates the transcription factor EB (TFEB) to up-regulate lysosomal function and eliminates the inhibitory effect of mTOR on ULK1 (unc-51 like autophagy activating kinase 1) to promote autophagy. Recent research showed that Rap can directly activate the lysosomal cation channel TRPML1 in an mTOR-independent manner. TRPML1 activation releases lysosomal calcium. Calcineurin functions as the sensor of the lysosomal calcium signal and activates TFEB, thus promoting lysosome function and autophagy. This finding has greatly broadened and deepened our understanding of the pharmacological roles of Rap. In this review, we briefly introduce the canonical Rap-mTOR-ULK1/TFEB signaling pathway, and then discuss the discovery of TRPML1 as a new target of Rap and the pharmacological potential of this novel Rap-TRPML1-Calcineurin-TFEB pathway.

Nesiritide protects endothelial function after balloon-induced trauma in the iliac artery in rabbits

To assess the effect of nesiritide on the endothelial function of iliac arteries following endothelia trauma. Right iliac artery trauma was created with a balloon catheter. Ten rabbits were treated with a 4-week subcutaneous injection of nesiritide at a fixed daily dose of 0.1mg/kg. Ten rabbits received daily normal saline injection. Plasma endothelin 1 (ET-1), nitric oxide (NO), and Von Willebrand Factor (vWF) were measured before and after the therapies. Tissue proliferating cell nuclear antigen (PCNA) was measured after the treatment. After the treatment, in the therapeutic group, the area under internal elastic membrane and the residual lumen area were higher than in the normal saline group (P <0.05). The plasma levels of ET-1 (91.6±6.8 vs 114.9±6.3 ng/L, P =0.001), vWF (134.6±10.8% vs 188.8±10.4%, P =0.001) and the ratio of PCNA positive expression (11.7±4.2% vs 36.2±11.4%, P =0.005) in the therapeutic group was lower than in the normal saline group, while the plasma levels of NO was higher (89.7±9.3 vs 43.5±5.3 µmol/L, P =0.001). Nesiritide inhibited remodeling of rabbit iliac artery following endothelial trauma. The inhibition of vascular remodeling may be related to the alleviated endothelial dysfunction and reduced expression of tissue proliferating cell nuclear antigen

A double-blind, randomized, placebo- and positive-controlled phase III trial of 1% benvitimod cream in mild-to-moderate plaque psoriasis / 中华医学杂志(英文版)

BACKGROUND@#Benvitimod cream, a novel synthetic small molecule, was effective in treating mild-to-moderate plaque psoriasis. We conducted a phase III clinical trial to assess the efficacy and safety of benvitimod cream in patients with mild-to-moderate plaque psoriasis.@*METHODS@#We randomly assigned 686 patients (2:1:1) to receive 1% benvitimod cream, 0.005% calcipotriol ointment or placebo twice a day for 12 weeks. The primary efficacy end points were the percentage of patients with a 75% or greater reduction from baseline in the psoriasis area and severity index (PASI 75) score and with a score of 0 or 1 in static physician's global assessment (sPGA) at week 12.@*RESULTS@#The results showed that 50.4% of patients in the benvitimod group achieved PASI 75, which was significantly higher than that in the calcipotriol (38.5%, P < 0.05) and placebo (13.9%, P < 0.05) groups. The proportion of patients achieving an sPGA score 0 or 1 was 66.3% in the benvitimod group and 63.9% in the calcipotriol group, which were both significantly higher than that in the placebo group (34%, P < 0.05). In the long-term follow-up study, 50.8% of patients experienced recurrence. After retreatment with 1% benvitimod, 73.3% of patients achieved an sPGA score of 0 or 1 again at week 52. Adverse events included application site irritation, follicular papules, and contact dermatitis. No systemic adverse reactions were reported.@*CONCLUSION@#During this 12-week study, benvitimod cream was demonstrated with high effectiveness and safety in patients with mild-to-moderate plaque psoriasis.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry (ChiCTR), ChiCTR-TRC-13003259; http://www.chictr.org.cn/showprojen.aspx?proj=6300.

Acupoint selection rules in treating gastroesophageal reflux disease with acupuncture in China based on data mining / 中国针灸

OBJECTIVE@#To analyze the rules of acupoint selection in the treatment of gastroesophageal reflux disease in China using data mining technology.@*METHODS@#The published literature of treating gastroesophageal reflux disease with acupuncture was retrieved from electronic databases from January 1, 1983 to December 1, 2019, including SinoMed, CNKI, Wanfang and VIP database. Acupuncture prescription database was established, and the rules of acupoint selection were explored by statistical software SPSS 20.0 and SPSS Modeler 18.0.@*RESULTS@#A total of 92 articles were included into this analysis, involving 92 acupuncture prescriptions, 76 acupoints. The total frequency of using these acupoints reached 549 times. Zhongwan (CV 12) was the most frequently used acupoint; the often selected meridians were conception vessel, stomach meridian, governor vessel, bladder meridian; the acupoints located at the abdomen, lower limbs and back were commonly selected; crossing points in the specific acupoints were commonly selected; the most frequently used group was Zusanli (ST 36)-Zhongwan (CV 12) and Neiguan (PC 6).@*CONCLUSION@#Treating gastroesophageal reflux disease by acupuncture in China is dominated by

Clinical Efficacy of Modified Guizhi Jia Gegen Tang on Qi Stagnation and Blood Stasis Syndrome of Cervical Spondylotic Radiculopathy and Function of Neck and Upper Limb / 中国实验方剂学杂志

<b>Objective::To investigate the clinical efficacy of modified Guizhi Jia Gegen Tang on cervical spondylotic radiculopathy (CSR) with Qi stagnation and blood stasis syndrome and its effect on cervical vertebral mobility, isometric muscle strength and pain-related factors. <b>Method::Totally 162 CSR patients with Qi stagnation and blood stasis syndrome were randomly divided into observation group (81 cases) and control group (81 cases). The observation group was given modified Guizhi Jia Gegen Tang orally, 150 mL/time, twice a day, while the control group was given Jingshu granule orally for 6 g/time, twice a day. Both groups were treated for 8 weeks. The changes of median nerve F wave conduction velocity, cervical vertebral mobility, isometric muscle strength, CSR 20 subscale score and visual analogue score (VAS) were recorded before and after treatment. The total effective rate and the cure rate were counted after treatment. The levels of serum pain-related factors (5-HT), nerve growth factor (NGF) and prostaglandin E₂ (PGE₂) were measured before and after treatment. <b>Result::The total effective rate of the observation group was 98.77%, and the cure rate was 40.74%, which were better than 83.95%and 7.41%of the control group (<italic>P</italic><0.01). Compared with before treatment, the conduction velocity of median nerve F wave, cervical vertebral mobility, isometric muscle strength and CSR 20 score increased, whereas VAS score, pain related factors 5-HT, NGF and PGE₂ content decreased in both groups (<italic>P</italic><0.01). Compared with control group, median nerve F wave conduction velocity, cervical vertebral mobility, isometric muscle strength and CSR 20 subscale scores increased, while VAS score decreased, pain related factors 5-HT, NGF and PGE₂ contents decreased in the observation group (<italic>P</italic><0.01). <b>Conclusion::Modified Guizhi Jia Gegen Tang is effective in treating CSR with Qi stagnation and blood stasis syndrome, and can significantly improve the neck and hand functions and relieve pain.

Clinical observation on gastroesophageal reflux asthma treated with needling technique / 中国针灸

OBJECTIVE@#To compare the clinical effect on gastroesophageal reflux asthma between the needling technique of acupuncture (acupuncture for promoting the circulation of the governor vessel and reducing the reversed ) and omeprazole enteric capsules (OME).@*METHODS@#A total of 60 patients with gastroesophageal reflux asthma were randomized into an acupuncture group and a western medication group, 30 cases in each one. The basic treatment for anti-bronchial asthma was provided in both of the groups. Additionally, OME was prescribed for oral administration in the western medication group, twice a day, 20 mg each time, for 8 weeks. In the acupuncture group, the needling technique of acupuncture was added. The needles were inserted at the sites inferior to the spinous processes of T to T. Acupuncture was given once in the morning on Tuesday, Thursday and Saturday respectively, totally for 8 weeks. Separately, before and after treatment, the score of reflux disease diagnostic questionnaire (RDQ), the score of asthma control test (ACT) and the tenderness threshold at the sites inferior to the spinous processes of T to T were observed and the clinical effect was evaluated in the two groups.@*RESULTS@#①The remarkably effective and curative rate was 46.7% (14/30) in the acupuncture group, higher than 3.3% (1/30) in the western medication group (<0.01). The asthma control rate was 66.7% (20/30) in the acupuncture group, higher than 13.3% (4/30) in the western medication group (<0.01). ②RDQ score after treatment was lower than that before treatment in either group (<0.05). The decrease range of RDQ score in the acupuncture group was larger than that of the western medication group (<0.05). After treatment, ACT score was increased as compared with that before treatment in either group (<0.05) and the increase range of ACT score in the acupuncture group was larger than that of the western medication group (<0.05). ③The tenderness thresholds at the sites inferior to the spinous processes of T to T and T to T were all increased after treatment as compared with those before treatment in the acupuncture group separately (<0.05). In the western medication group, the thresholds were only increased at the sites inferior to the spinous processes of T, T and T after treatment as compared with those before treatment separately (<0.05). After treatment, the tenderness thresholds at T to T in the acupuncture group were all higher than the western medication group (<0.05).@*CONCLUSION@#The needling technique of acupuncture effectively relieves the symptoms of gastroesophageal reflux asthma and improves the quality of life in the patients and its effect is better than omeprazole enteric capsules.

Professor 's concept and experience in the diagnosis and treatment of gastroesophageal reflux disease / 中国针灸

In view of the five major misunderstandings in the clinical understanding of gastroesophageal reflux disease in traditional Chinese medicine, that is, wrong main symptoms, wrong position of the disease, wrong character of the disease, treating acid with acid, and attaching importance to drugs and neglecting acupuncture-moxibustion in treatment, Professor has proposed the corresponding solving strategies, which includes grasping the main disease, carefully examining the disease position, distinguishing the character of disease, and no acid suppression for acid regurgitation. In addition, Professor highly values the external treatment of traditional Chinese medicine. In particular, the acupuncture therapy of " (promote the circulation of the governor vessel and reduce the reversed )" based on many years of clinical experience provides new ideas and methods for the diagnosis and treatment of gastroesophageal reflux disease in traditional Chinese medicine.

Identification of first definite case of COVID-19 in Jinghu District of Wuhu City / 上海预防医学

Objective To report an epidemiological investigation on identification of the first case of coronavirus disease 2019(COVID-19) in Jinghu District of Wuhu City. Methods A field epidemiologic survey was conducted on the case.Throat swab sample was tested using real-time reverse transcription polymerase chain reaction (RT-PCR) assay to detect the nucleic acid of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).The close contacts of the case were tracked and appropriate prevention and control measures were implemented. Results The case had lived in Xi′an usually and arrived in Wuhu from Xi′an on January 22 of 2020.On January 23, the patient developed respiratory symptoms but the diagnosis of COVID-19 was excluded after two negative SARS-CoV-2 nucleic acid tests.On January 26, the patient was admitted to hospital again due to fever, chest tightness and other symptoms.On January 27, the patient tested positive for SARS-CoV-2 nucleic acid and was confirmed with COVID-19 after a review by the Anhui Provincial Center for Disease Control and Prevention.The case had no history of travel or residence in Wuhan, and no history of contact with wildlife or markets, however, had close contact with a confirmed COVID-19 patient before returning to Wuhu. Conclusion Based on the epidemiological history, clinical symptoms and the results of the SARS-CoV-2 nucleic acid test, the patient is determined as the first reported case of COVID-19 in Jinghu District of Wuhu City.

Clinical Observation on Effect of Toujie Quwen Granules in Treatment of COVID-19 / 中国实验方剂学杂志

Objective:To analyze the clinical efficacy of traditional Chinese medicine（TCM） Toujie Quwen granules in the treatment of coronavirs disease-2019（COVID-19） in the early stage, and its effect on relevant inflammatory index expression of COVID-19. Method:A total of 65 COVID-19 cases were diagnosed and divided into 2 groups: the treatment group （n=32） and the control group （n=33）. Before and after treatment，TCM syndrome score，WBC，LYM，LYM%，NEU%，PCT，CRP and D-dimer were compared. Result:After 10 days of treatment，the TCM syndrome score of the treatment group was significantly reduced（P<0.05），while the absolute value of lymphocyte was up-regulated，with statistically significant differences（P<0.05）， according to the inter-group comparison, there were statistically significant differences in the absolute value of LYM and NEU%（P<0.05）. There was no significant difference in WBC count and LYM%. The levels of CRP，PCT and D-dimer in the two groups were reduced after treatment，with statistically significant differences between two groups （P<0.05）. After treatment，the differences of CRP and PCT was statistically significant between both groups（P<0.05），but the difference in D-dimer was not statistically significant. There was no difference in the effect of chest CT examination between the both groups. Conclusion:The clinical syndrome and inflammatory particles of COVID-19 can be alleviated by early and timely use of Toujie Quwen granules.

Effect of Duhuo Xuduan Tang for Oral Administration and Iontophoresis on SDF-1/CXCR4 Signaling Pathway and Relevant Factors of Cartilage Degradation in Knee Joint Fluid of Patients with Knee Osteoarthritis with Liver and Kidney Deficiency / 中国实验方剂学杂志

Objective::To observe the clinical efficacy of Duhuo Xuduan Tang for oral administration and iontophoresis in the treatment of knee osteoarthritis (KOA) with liver and kidney deficiency and its effect on stromal cell-derived factor-1 (SDF-1)/C-X-C chemokine receptor type 4 (CXCR4) signaling pathway. Method::Totally 150 KOA patients with deficiency of liver and kidney diagnosed in the Teaching Hospital of Tianjin University of Traditional Chinese Medicine(TCM) were randomly divided into control group, oral TCM group and iontophoresis group, with 50 cases in each group. The control group was given glucosamine sulfate capsule, 0.5 g/time, twice a day, while the oral TCM group was given Duhuo Xuduan Tang, 150 mL/time, twice a day. In the iontophoresis group, Duhuo Xuduan Tang was administered at Kuangu acupoint, Xiguan acupoint, Xiyan acupoint and Dubi acupoint for iontophoresis for 30 minutes, once a day. All of the three groups were treated for 4 weeks. The swelling degree and the pain degree of knee joint before and after treatment were observed, and the clinical efficacy was recorded. The protein contents of SDF-1, CXCR4, matrix metalloproteinase-3 (MMP-3) and matrix metalloproteinase-13 (MMP-13) in knee joint fluid before and after treatment were detected by enzyme-linked immunosorbent assay (ELISA). Result::The efficacy of oral TCM group was better than that of iontophoresis group and control group, and the recurrence rate was the lowest (P<0.05). Compared with before treatment, the tenderness increased, whereas visual analogue scale(VAS) score, knee swelling score, The Western Ontario and McMaste Universities (WOMAC) score and SDF-1, CXCR4, MMP-3 and MMP-13 protein content in knee joint fluid decreased in oral TCM group after treatment, which were better than those in iontophoresis group and control group (P<0.05). Conclusion::Duhuo Xuduan Tang for oral administration and iontophoresis has an obvious effect on KOA with liver and kidney deficiency, with the best effect through oral administration. Its mechanism may be related to the inhibition of SDF-1/CXCR4 inflammatory signaling pathway and cartilage decomposition.

Discussion on Forensic Identification of the Rationality of Medical Expense / 法医学杂志

In cases on compensation for personal injury, the issue of medical expense compensation involves the vital interests of the compensation obligor, the injured party and the medical institution. The rationality of medical expenses is likely to be controversial, however, there is no unified standard and stipulation for the medical expense rationality identification in forensic clinical identification at present, therefore, in the practice of judicial expertise, expert opinions easily become confused, and the legitimate rights of the parties could be infringed, which affects the impartiality and authority of judicial expertise. This article starts with the concept of medical expense and the rationality of medical expense and the reasons for disputes over the rationality of medical expense, to put forward the basic principles that should be followed in the identification of rationality of medical expenses, for peer reference.