Bioinformatic Analysis Identifies Potential Extracellular Matrix Related Genes in the Pathogenesis of Early Onset Preeclampsia.

Early-onset preeclampsia (EOPE) is a complex pregnancy complication that poses significant risks to the health of both mothers and fetuses, and research on its pathogenesis and pathophysiology remains insuffcient. This study aims to explore the role of candidate genes and their potential interaction mechanisms in EOPE through bioinformatics analysis techniques. Two gene expression datasets, GSE44711 and GSE74341, were obtained from the Gene Expression Omnibus (GEO) to identify differentially expressed genes (DEGs) between EOPE and gestational age-matched preterm control samples. Functional enrichment analysis was performed utilizing the kyoto encyclopedia of genes and genomes (KEGG), gene ontology (GO), and gene set enrichment analysis (GSEA). A protein-protein interaction (PPI) network was constructed using the STRING database, and hub DEGs were identified through Cytoscape software and comparative toxicogenomics database (CTD) analysis. Furthermore, a diagnostic logistic model was established using these hub genes, which were confirmed through reverse transcription polymerase chain reaction (RT-PCR). Finally, immune cell infiltration was analyzed using CIBERSORT. In total, 807 DEGs were identified in the GSE44711 dataset (451 upregulated genes and 356 downregulated genes), and 787 DEGs were identified in the GSE74341 dataset (446 upregulated genes and 341 downregulated genes). These DEGs were significantly enriched in various molecular functions such as extracellular matrix structural constituent, receptor-ligand activity binding, cytokine activity, and platelet-derived growth factor. KEGG and GSEA annotation revealed significant enrichment in pathways related to ECM-receptor interaction, PI3K-AKT signaling, and focal adhesion. Ten hub genes were identified through the CytoHubba plugin in Cytoscape. Among these hub genes, three key DEGs (COL1A1, SPP1, and THY1) were selected using CTD analysis and various topological methods in Cytoscape. The diagnostic logistic model based on these three genes exhibited high efficiency in predicting EOPE (AUC = 0.922). RT-PCR analysis confirmed the downregulation of these genes in EOPE, and immune cell infiltration analysis suggested the significant role of M1 and M2 macrophages in EOPE. In conclusion, this study highlights the association of three key genes (COL1A1, SPP1, and THY1) with EOPE and their contribution to high diagnostic efficiency in the logistic model. Additionally, it provides new insights for future research on EOPE and emphasizes the diagnostic value of these identified genes. More research is needed to explore their functional and diagnostic significance in EOPE.

Statistical analysis of 4 types of neck whiplash injuries based on classical meridian theory.

As one component of the Chinese medicine meridian system, the meridian sinew (Jingjin, (see text), tendino-musculo) is specially described as being for acupuncture treatment of the musculoskeletal system because of its dynamic attributes and tender point correlations. In recent decades, the therapeutic importance of the sinew meridian has become revalued in clinical application. Based on this theory, the authors have established therapeutic strategies of acupuncture treatment in Whiplash-Associated Disorders (WAD) by categorizing four types of neck symptom presentations. The advantage of this new system is to make it much easier for the clinician to find effective acupuncture points. This study attempts to prove the significance of the proposed therapeutic strategies by analyzing data collected from a clinical survey of various WAD using non-supervised statistical methods, such as correlation analysis, factor analysis, and cluster analysis. The clinical survey data have successfully verified discrete characteristics of four neck syndromes, based upon the range of motion (ROM) and tender point location findings. A summary of the relationships among the symptoms of the four neck syndromes has shown the correlation coefficient as having a statistical significance (P < 0.01 or P < 0.05), especially with regard to ROM. Furthermore, factor and cluster analyses resulted in a total of 11 categories of general symptoms, which implies syndrome factors are more related to the Liver, as originally described in classical theory. The hypothesis of meridian sinew syndromes in WAD is clearly supported by the statistical analysis of the clinical trials. This new discovery should be beneficial in improving therapeutic outcomes.

[Effect of Negative Emotions on Serum Levels of Adrenocorticotropic Hormones and Neuropeptide Y in Hepatitis B Liver Cirrhosis Patients].

OBJECTIVE: To explore the effect of negative emotions on serum levels of adrenocorticotropic hormone (ACTH) and neuropeptide Y (NYP) in hepatitis B liver cirrhosis (HBLC) patients. METHODS: Totally 617 HBLC patients were assigned to the negative emotion group (415 cases) and the non-negative emotion group (202 cases) judged by negative emotions. Case numbers of various grading Child-Pugh were recorded in the two groups. Their liver functions were compared between the two groups. Serum levels of ACTH and NPY were detected using double antibody sandwich enzyme-linked immunosorbent assay (ELISA) in the two groups. RESULTS: There was no statistical difference in Child-Pugh grading between the two groups (χ2 = 0.65, P = 0.72). Compared with the non-negative emotional group, serum ACTH levels decreased significantly in the negative emotion group with statistical difference (P < 0.05). There was no statistical difference in serum ACTH levels between the two groups (P > 0.05). CONCLUSION: The negative emotion of HBLC patients was not related to the serum ACTH level, but to relatively lower-concentration serum NPY levels.

Autoimmune diseases and risk of gestational diabetes mellitus: a Mendelian randomization study.

AIMS: Observational studies have reported that autoimmune diseases are associated with gestational diabetes mellitus (GDM), but the causality is unknown. The study aimed to evaluate the potential causal effect of autoimmune diseases on GDM. METHODS: A two-sample Mendelian randomization (MR) study was designed using the summary statistics of GDM (123,579 individuals) and three common autoimmune diseases, including inflammatory bowel disease (IBD, 59,957 individuals), rheumatoid arthritis (RA, 80,799 individuals) and systemic lupus erythematosus (SLE, 14,267 individuals), from the genome-wide association study (GWAS). The fixed-effects inverse variance weighted (IVW) was used to deduce the causal association between autoimmune diseases and GDM, and sensitivity analyses were further performed. RESULTS: The inverse variance weighting (IVW) method showed that RA and SLE increased the risk of GDM (RA: OR = 1.076, 95%CI = 1.033-1.122, P = 4.649E-04; SLE: OR = 1.025, 95%CI = 1.001-1.049, P = 0.044). But there were no any associations of IBD with GDM (P > 0.05). No significant horizontal pleiotropy was found by MR Egger regression (IBD: P for intercept = 0.905; RA: P for intercept = 0.103; SLE = P for intercept = 0.608). CONCLUSION: This two-sample MR study found that both SLE and RA are positively associated with the risk of GDM. Our findings provide help for the future prevention and treatment of GDM to reduce associated maternal and fetal complications. However, more research is needed to obviate the role of the GC and the HCQ to ensure this relationship is causal.

The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum.

Objective: This study investigated the predicting value of the ratio of levator hiatus diameter (LHS) to fetal head circumference (HC) in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum. Methods: A total of 120 first-time women who gave vaginal delivery at 37 weeks of pregnancy were selected as the subjects in our hospital during March 2021 to March 2022. The subjects were divided into the second stage of labor > 1 h group and the second stage of labor ≤ 1 h group, according to the delivery time of the second stage of labor. According to the 6-week postpartum follow-up ultrasound examination with or without levator ani injury, they were divided into levator ani injury group and no injury group. All primipara women underwent three-dimensional ultrasonography at 37 weeks of gestation, and the resting LHS, Valsalva LHS, fetal HC and the ratio of resting LHS and fetal HC were compared. The correlation between these factors and the length of the second labor stage was analyzed using Pearson correlation analysis. The value of these factors in predicting labor progression and postpartum levator ani injury was assessed by receiver operating characteristic (ROC) curves. Results: The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the levator ani injury group were lower than these in the no injury group, while fetal HC in the levator ani injury group was higher than that in the no injury group (P < 0.05). The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the second stage of labor > 1 h group were lower than these in the second stage of labor ≤ 1 h group, while fetal HC in the second stage of labor > 1 h group was higher than that in the second stage of labor ≤ 1 h group (P < 0.05). A significant negative correlation was observed between resting LHS/HC and total labor process (=-0.333, P < 0.01). ROC curve analysis showed that the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting prolongation of the second stage of labor were 0.741, 0.740, 0.702, and 0.843 respectively. Besides, the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting the total labor process were 0.657, 0.684, 0.768, and 0.836 respectively. The AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting postpartum levator ani muscle injury were 0.769, 0.773, 0.747, and 0.885 respectively.These results suggested that the ratio of resting LHS and fetal HC may have certain clinical value in predicting levator ani injury in pregnant women. Conclusion: LHS, fetal HC and the ratio of resting LHS and fetal HC are significantly correlated with labor progression and postpartum levator ani injury, which have certain value in predicting labor progress and postpartum levator ani injury. Therein, the ratio of resting LHS and fetal HC has the highest predictive value, and early detection of the ratio of resting LHS and fetal HC is helpful to guide the selection of appropriate delivery mode.

Protective role of metformin in preeclampsia via the regulation of NF-κB/sFlt-1 and Nrf2/HO-1 signaling pathways by activating AMPK.

INTRODUCTION: Preeclampsia (PE) is a pregnancy complication that leads to hypertension and proteinuria and causes maternal mortality. Metformin (MET) is an oral hypoglycemic agent that activates AMPK-regulated signaling pathways and inhibits inflammation and oxidative stress responses. This study explored MET's roles and molecular mechanisms in PE. METHODS: The protein or mRNA expression of signaling pathways and inflammation-related genes were detected by Western blotting and RT-qPCR and cell viability was analyzed with MTT. In addition, flow cytometry was used to assess apoptosis, and mitochondrial membrane potential was detected using JC-1 staining with flow cytometry. Moreover, LDH Cytotoxicity Assay Kit detected the release of LDH, and ROS, MDA, or SOD kits detected oxidative stress-related factors. RESULTS: MET significantly inhibited inflammatory damage and oxidative stress responses in LPS-induced HTR-8/SVneo cells. Besides, MET could activate AMPK and then affect NF-κB/sFlt-1 and Nrf2/HO-1 signaling pathways in LPS-induced HTR-8/SVneo cells. Compound C (an AMPK inhibitor) significantly reversed MET's effects on LPS-stimulated HTR-8/SVneo cells. DISCUSSION: MET attenuated inflammatory and oxidative stress of HTR-8/SVneo cells in PE by activating AMPK to regulate NF-κB/sFlt-1 and Nrf2/HO-1 signaling pathways, suggesting that MET was a potential therapeutic drug for PE.

Xiaopiyishen Herbal Extract Granule Improves the Quality of Life among People with Fatigue-Predominant Subhealth and Liver-Qi Stagnation and Spleen-Qi Deficiency Syndrome.

To observe the effects of Xiaopiyishen Herbal Extract Granule (XPYS-HEG) on the quality of life in people with fatigue-predominant subhealth (FPSH) and liver-qi stagnation and spleen-qi deficiency syndrome, the participants were allocated randomly to the treatment group (XPYS, n = 100) and the control group (placebo, n = 100) in this study. The study period was 18 weeks (6 weeks for the intervention and 12 weeks for followup). The results show that there were no differences between the two groups for the scores of eight factors on the SF-36 (Chinese version of the SF-36 universal quality-of-life scale) at baseline. Compared with the baseline score, intervention with XPYS-HEG led to a significant increase in scores for the factor of bodily pain at the end of the 6th week. Compared with the score at the end of the 6th week, the score for the factor of mental health in the XPYS group significantly increased at the end of the 18th week. Therefore, XPYS-HEG could partially improve the quality of life for people with FPSH and liver-qi stagnation and spleen-qi deficiency syndrome, which can ease bodily pain, stimulate a positive mood, and ease a negative mood.

[Weighting coefficients of symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis based on expert questionnaire investigation].

OBJECTIVE: To define the weighting coefficients of the symptoms and signs in the diagnosis of corresponding traditional Chinese medicine (TCM) syndrome elements of ulcerative colitis based on expert questionnaire investigation. METHODS: The questionnaire included eight syndrome elements of location and 11 syndrome elements relating to disease characteristics. Experts who answered the questionnaire were titled as associate chief physician or above, and had been practicing as professionals in general practice of medicine of digestive system for a long time. They came from 15 third-grade class-A hospitals (6 provinces and Beijing) in China. The weighting coefficients of the symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis were identified preliminarily based on consent degree of the experts (mean value and variation coefficient). RESULTS: There were 9, 6, 14, 5, 9, 8, 12 and 2 symptoms and signs corresponding to 8 TCM syndrome elements related to disease location and the ranges of weighting coefficients were listed as follows: liver, from 7.49 to 4.18; heart, from 6.90 to 5.51; spleen, from 7.96 to 5.55; lung, from 6.30 to 5.27; kidney, from 7.82 to 5.71; stomach, from 7.53 to 6.15; large intestine, from 8.40 to 6.70; bowel collaterals, from 8.49 to 6.41. Numbers of symptoms and signs corresponding to 11 TCM syndrome elements related to disease nature were 13, 8, 17, 18, 17, 18, 6, 11, 2, 10 and 11 and the ranges of weighting coefficients were listed as follows: qi deficiency, from 7.44 to 5.60; blood deficiency, from 7.90 to 5.59; yin deficiency, from 6.88 to 4.91; yang deficiency, from 7.54 to 5.57; dampness, from 7.91 to 4.96; excess heat (fire), from 7.13 to 5.69; excess cold, from 7.51 to 6.14; qi stagnation, from 7.38 to 5.88; qi sinking, from 7.65 to 7.43; blood stasis, from 7.60 to 5.79; fluid retention, from 7.08 to 4.46. CONCLUSION: On the basis of previous document research and clinical research in ulcerative colitis, the expert questionnaire can collect consensus opinions of experts. The weighting coefficients of the symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis are defined preliminarily. Thereby it will lay the foundation for establishing differentiation criteria of ulcerative colitis based on TCM syndrome elements.

Puerarin protects against H2O2-induced apoptosis of HTR-8/SVneo cells by regulating the miR-20a-5p/VEGFA/Akt axis.

INTRODUCTION: Preeclampsia seriously affects the health of pregnant women and fetuses. It has been reported that puerarin has a positive therapeutic effect on the treatment of preeclampsia. In this study, oxidative stress-induced trophoblast cell injury was established to explore the potential interaction between puerarin and preeclampsia. METHODS: A CCK-8 assay was performed to investigate the effect of puerarin on the viability of HTR-8/SVneo cells. To mimic oxidative stress-induced trophoblast cell injury, human villous trophoblasts (HTR-8/SVneo) were treated with H2O2. Then, the relationships among MMP2, VEGFA and miR-20a-5p in HTR-8/SVneo cells were confirmed using a dual-luciferase reporter assay. Finally, Western blot assays were performed to measure the expression levels of MMP2, VEGFA, p-Akt, Akt, Bcl-2 and cleaved caspase 3. RESULTS: In this study, puerarin eliminated H2O2-induced cytotoxicity of HTR-8/SVneo cells. In addition, puerarin was able to reverse H2O2-induced apoptosis and metastasis inhibition in cells. Meanwhile, puerarin significantly abrogated H2O2-induced mitochondrial membrane potential (MMP) decline in HTR-8/SVneo cells. And, MMP2 and VEGFA were identified as direct targets of miR-20a-5p. Furthermore, puerarin reversed H2O2-induced growth inhibition in HTR-8/SVneo cells by regulating the miR-20a-5p/VEGFA/Akt axis. DISCUSSION: All these data indicated that puerarin could abolish H2O2-induced growth inhibition in HTR-8/SVneo cells by regulating the miR-20a-5p/VEGFA/AKT axis.

[Effects of Xiaopi Yishen herbal extract granules in treatment of fatigue-predominant subhealth due to liver-qi stagnation and spleen-qi deficiency: a prospective, randomized, placebo-controlled and double-blind clinical trial].

BACKGROUND: The demand for effective intervention for subhealth conditions is growing with increasing numbers of people being in a state of subhealth with a poor quality of life. Future research and evaluation of the treatment methods for subhealth conditions from the perspective of traditional Chinese medicine (TCM) may provide an important direction for developing effective management of these conditions. OBJECTIVE: To evaluate the efficacy and safety of Xiaopi Yishen herbal extract granules (XPYS-HEG), a compound traditional Chinese herbal medicine for relieving fatigue and promoting a cheerful spirit for the treatment of people with fatigue-predominant subhealth due to liver-qi stagnation and spleen-qi deficiency. DESIGN, SETTING PARTICIPANTS AND INTERVENTIONS: A multi-center, randomized, double-blinded, placebo-controlled clinical study was undertaken. The study period was 18 weeks, including 6 weeks for intervention and 12 weeks for follow-up. Participants were recruited from medical center and outpatient clinics of three hospitals in China, i.e. Xiaotangshan Hospital of Beijing, the First Affiliated Hospital of Henan University of TCM and the Affiliated Hospital of Liaoning University of TCM. Two hundred participants who met the criteria of fatigue-predominant subhealth and liver-qi stagnation and spleen-qi deficiency in TCM were allocated randomly to the treatment group (XPYS, n=100) and control group (placebo, n=100). MAIN OUTCOME MEASURES: The total score of Fatigue Scale-14 (FS-14) was used to evaluate the fatigue status of subjects and the extent of liver-qi stagnation and spleen-qi deficiency syndrome was also recorded. RESULTS: Three cases in the XPYS group withdrew from the trial. There were 200 subjects who entered to full analysis set (FAS) analysis and 197 subjects fitted in the per-protocol set (PPS) analysis. (1) According to the score changes of FS-14, the effectiveness rates in the XPYS and placebo group were as follows: 14.0% vs 9.0% (FAS) and 14.4% vs 9.0% (PPS) for complete remission, 19.0% vs 15.0% (FAS) and 19.6% vs 15.0% (PPS) for obvious effects, 39.0% vs 26.0% (FAS) and 39.2% vs 26.0% (PPS) for effective, and 72.0% vs 50.0% (FAS) and 73.2% vs 50.0% (PPS) for complete efficacy. The efficacy of XPYS-HEG was superior to the placebo statistically (P<0.05). (2) According to the score changes of TCM syndrome, the effectiveness rates in the XPYS group and placebo group were as follows: 1.0% vs 0.0% (FAS) and 1.0% vs 0.0% (PPS) for complete remission, 20.0% vs 7.0% (FAS) and 19.6% vs 7.0% (PPS) for obvious effects, 29.0% vs 24.0% (FAS) and 29.9% vs 24.0% (PPS) for effective, and 50.0% vs 31.0% (FAS) and 50.5% vs 31.0% (PPS) for complete efficacy. The efficacy of XPYS-HEG was superior to that of placebo statistically (P<0.05). (3) The follow-up results at 12 weeks and 18 weeks showed that the efficacy of XPYS-HEG was superior to that of placebo statistically (P<0.05). (4) No adverse effects were found in the XPYS group. CONCLUSION: It can be concluded that XPYS-HEG is effective and safe for the treatment of people with fatigue-predominant subhealth due to liver-qi stagnation and spleen-qi deficiency.

The Value of Prenatal First Systolic Blood Pressure Can Predict Severe Preeclampsia and Birth Weight in Patients With Preeclampsia.

BACKGROUND: Preeclampsia is a serious complication of pregnancy that threatens the safety of the fetus and mother. We assessed the relationship between systolic blood pressure (SBP) in the early pregnancy stage (12 weeks) in patients with preeclampsia and the development of severe eclampsia and birth weight. METHODS: Patients were categorized based on the quartiles of the prenatal first SBP level. Logistic regression analysis was performed to assess whether prenatal first SBP was a risk factor for low birth weight and severe preeclampsia. The area under the receiver-operating characteristic curve (AUC) of sensitivity and specificity were used to predict the risk of low birth weight and severe preeclampsia. RESULTS: A total of 333 patients with preeclampsia were enrolled. There were 162 (48.6%) patients with severe preeclampsia and 270 (81.08%) cesareans. Group I patients with a prenatal first SBP ≤ 119 mmHg prenatal had a higher birth weight. Multiple logistic regression analysis showed that serum creatinine (p = 0.025), prenatal first SBP (p = 0.029), S-preeclampsia (p = 0.003), gestational age (p < 0.001), total cholesterol (TC) (p < 0.001), and low-density lipoprotein (LDL) (p < 0.001) were independent risk factors for low birth weight. Multiple logistic regression analysis showed that prenatal first SBP (p = 0.003), TC (p = 0.002), and B-type natriuretic peptide (BNP) (p < 0.001) were independent risk factors for severe preeclampsia. Compared with Group I (SBP ≤ 119 mmHg), the incidence of low birth weight for patients in groups III (131 ≤ SBP ≤ 138 mmHg) and IV (SBP ≥ 139 mmHg) was significantly higher. Even after correcting for age, gestational age, and biochemical indices, the difference remained statistically significant. The risk of diagnosed severe preeclampsia for patients in Groups IV (SBP ≥ 139 mmHg), III (131 ≤ SBP ≤ 138 mmHg), and II (120 ≤ SBP ≤ 130 mmHg) was significantly higher than that in Group I (SBP ≤ 119 mmHg). The AUC of the prenatal first SBP for predicting low birth weight and severe preeclampsia was 0.676 (95% CI 0.618-0.733, p < 0.001) and 0.727 (95% CI 0.673-0.781, p < 0.001), respectively, in patients with preeclampsia. CONCLUSIONS: Prenatal first SBP was associated with birth weight and severe preeclampsia. Higher prenatal first SBP in patients with preeclampsia can predict low birth weight and severe preeclampsia.

[The systemic evaluation and clinical significance of immunological function for advanced lung cancer patients].

BACKGROUND AND OBJECTIVE: The actual evaluation of immunological function is significant for studing the tumor development and devising a treatment in time. The aim of this study is to evaluate the immunological function of advanced lung cancer patients systematically, and to discuss the clinical significance. METHODS: The nucleated cell amounts of advanced lung cancer patients and the healthy individuals were counted. The immune cell subsets and the levels of IL-4, INF-gamma, perforin and granzyme in CD8+T cells by the flow cytometry were measured. The proliferation activity and the inhibition ratio of immune cells to several tumor cell lines were evaluated by MTT assay. RESULTS: The absolute amounts and subsets of T, B, NK cells of advanced lung cancer patients were lower than the healthy individuals (P < 0.05); However, the proportion of regulatory T cells of advanced lung cancer patients (4.00 +/- 1.84)% was lower than the healthy individuals (1.27 +/- 0.78)% (P < 0.05). The positive rates of IFN-gamma perforin, granzyme in CD8+T cells decreased while them in IL-4 did not in the advanced lung cancer patients compared to the healthy control group (P < 0.05). The proliferation activity of immune cells, the positive rate of PPD masculine and the inhibition ratio to tumor cells in the advanced lung cancer patients was lower than the healthy subsets obviously (P < 0.05). CONCLUSION: There was a significant immune depression in the advanced lung cancer patients compared to the healthy individuals.

[Common syndrome factors of menopausal syndrome based on questionnaire investigation among experts].

OBJECTIVE: To select the common syndrome factors of menopausal syndrome through questionnaire investigation among experts. METHODS: Firstly, a questionnaire was constructed on the basis of our previous research, and then investigation of the experts by the questionnaire was carried out. The experts came from twelve tertiary hospitals (6 cities) in China, and engaged in clinical practice of gynecology of traditional Chinese medicine (TCM) or integrated traditional Chinese and Western medicine. The common TCM syndrome factors of menopausal syndrome were selected based on consent degree of the experts in mean value, full marks ratio, rank sum and variation coefficient. RESULTS: One hundred sets of the questionnaires were sent out and ninety-eight sets were returned back. The callback rate was 98%. In accordance with cumulative percentage of expert agreement and complete agreement more than 50% and the coefficient variation less than 0.25, we confirmed the common TCM syndrome factors of menopause syndrome. The syndrome factors related to disease location were kidney, liver, heart, and spleen, and those related to the nature of disease were yin deficiency, deficiency of essence, yang deficiency, hyperactivity of yang, qi deficiency, qi stagnation, blood deficiency, and blood stasis. CONCLUSION: Expert consultation questionnaire can collect consensus opinions of experts and is effective for identifying common TCM syndrome factors of a disease. The TCM syndrome factors acquired through the study may provide the evidence for establishment of TCM syndrome diagnosis criteria for the disease in future.

[Common syndrome factors of traditional Chinese medicine in chronic renal failure based on the questionnaire investigation among experts].

OBJECTIVE: To screen common traditional Chinese medicine (TCM) syndrome factors of chronic renal failure (CRF) via questionnaire investigation among experts. METHODS: A questionnaire was developed based on the results of our previous researches. The investigation was carried out with the questionnaire among experts who are engaged in clinical research and treatment of nephrosis with the title of chief or associate chief physician from 15 hospitals in China. Common TCM syndrome factors of CRF were obtained based on the data analysis of the mean value on general evaluation, cumulative percentage and coefficient of variation. RESULTS: A total of 114 sets of the questionnaire were sent out and all of them were returned back, 113 of which were effective. The recovery rate is 100%. The TCM syndrome factors were regarded as common factors of CRF syndrome if the cumulative percentage was more than or equal to 60% and the coefficient of variation was less than or equal to 0.35. The syndrome factors related to the disease location were the kidney, spleen, stomach, heart, and lung; the syndrome factors related to the disease type were dampness, turbid toxin, blood stasis, water retention, and phlegm which belong to excess type, and qi deficiency, yin deficiency, yang deficiency, blood deficiency, and essence deficiency which belong to deficiency type. CONCLUSION: The common TCM syndrome factors of CRF were obtained from the representative experts through the questionnaire investigation among the experts. The results enable us to have a deeper understanding of the disease in view of TCM compared with the previous literature data and may contribute to the establishment of TCM syndrome diagnosis criteria of the disease in the future.

[Distribution characteristics of traditional Chinese medicine syndromes and their elements in people with subhealth fatigue].

OBJECTIVE: To investigate the characteristics of traditional Chinese medicine (TCM) syndromes and their elements in people with subhealth fatigue. METHODS: The TCM symptoms in line with the diagnostic criteria of subhealth fatigue status were collected by clinical investigations and using information collection form based on TCM four diagnostic methods. Referred to Clinical Guidelines of Chinese Medicine on Subhealth and other related standards, the syndrome type was identified in accordance with clinical symptoms of each patient with subhealth fatigue by two physicians. The data of syndrome differentiation were analyzed by descriptive statistical analysis. RESULTS: There were 81 syndrome types from 495 cases of subhealth fatigue. There were 24 syndrome types after separation, and the top ten were liver stagnation and spleen deficiency, stagnation of liver qi, hyperactivity of liver fire, disharmony between liver and stomach, damp obstruction due to spleen deficiency, deficiency of both heart and spleen, yin deficiency of liver and kidney, yang deficiency of spleen and kidney, stagnation of gallbladder and disturbance of phlegm, and internal disturbance of phlegm-heat. There were 17 syndrome elements, including seven disease location elements and ten disease nature elements. The disease location elements were liver, spleen, kidney, stomach, heart, gallbladder and lung. The disease nature elements were qi stagnation, qi deficiency, exuberance of fire (heat), damp obstruction, phlegm obstruction, yin deficiency, adverse flow of qi, yang deficiency, blood deficiency, and blood stasis. CONCLUSION: Syndrome types of subhealth fatigue involve in deficiency syndrome, excess syndrome, and mixture of deficiency and excess syndromes. The syndrome elements of disease location involve five zang organs and two fu organs, and the liver and spleen were the most frequently involved organs. The syndrome elements of disease nature involve deficiency and excess. Qi stagnation is most frequently involved in the excess syndrome, and qi deficiency is most frequently involved in the deficiency syndrome.

[A perspective of developing syndrome diagnostic criteria based on syndrome factors and combination of disease in modern medicine system and syndrome in traditional Chinese medicine system].

Syndrome differentiation treatment is the traditional model of diagnosis and treatment of diseases in traditional Chinese medicine (TCM). To establish scientific diagnostic criteria of TCM syndrome is one of the key points in TCM study. In this paper, the basic models of the relevant diagnostic criteria of TCM syndrome and existed problems were reviewed. The authors pointed out the advantages of establishing diagnostic criteria of TCM syndrome based on TCM syndrome factors and combination of disease in Western medicine system and TCM syndrome, in which not only the characteristics of the disease in Western medicine were considered, but also the complexity and flexibility of syndrome identification and convenient application in clinical practice were resolved. The basic model and frame of the above diagnostic criteria and the procedures and methods used in developing the diagnostic criteria were also described and discussed.

Transjugular intrahepatic portosystemic stent shunt placement and embolization for hemorrhage associated with rupture of anorectal varices.

Portal hypertension can lead to ectopic varices, which occur most frequently in the rectum. Rectal variceal bleeding in patients with portal hypertension is rare but can be life-threatening if not diagnosed and treated in a timely manner. However, no specific treatment guidelines have been established for rectal variceal bleeding. We herein report a case involving a woman with portal hypertension due to autoimmune liver disease who was successfully treated with a transjugular intrahepatic portosystemic stent shunt and variceal embolization. We recommend treatment of refractory ectopic variceal bleeding with a transjugular intrahepatic portosystemic stent shunt in combination with embolization.

[Expression of NF-kappaB and COX-2 mRNA in rats with phlegm obstruction due to lung-deficiency].

OBJECTIVE: To study the role of nuclear factor-kappa B (NF-kappaB) and cycloxygenase-2 (COX-2) in the onset of phlegm obstruction due to lung-deficiency in rats and the therapeutic mechanism of Huatan Recipe. METHODS: Twenty-four SD rats were randomly divided into normal group, model group and treatment group, with 8 rats in each group. The rats in the model group and treatment group were exposed to sulfur dioxide and cold wind to establish the rat model of phlegm obstruction due to lung-deficiency, and the rats in the treatment group were also treated with Huatan Recipe, a compound traditional Chinese medicine. The expression of NF-kappaB in the bronchial epithelial cells of the rats was tested with the method of immunohistochemistry, and the COX-2 mRNA in the lung tissues of the rats was measured by using reverse transcription-polymerase chain reaction. RESULTS: The expressions of NF-kappaB and COX-2 mRNA in rats of the model group were higher than those of the normal group (P<0.01), and the expressions of NF-kappaB and COX-2 mRNA in rats of the treatment group were obviously lower than those of the model group (P<0.01). CONCLUSION: The NF-kappaB and COX-2 play an important role in the onset of phlegm obstruction in rats. Huatan Recipe may prevent the development of phlegm obstruction by down-regulating the expressions of NF-kappaB and COX-2 mRNA.

Distribution characteristics of meridian sinew (jingjin) syndrome in 313 cases of whiplash-associated disorders.

OBJECTIVE: To investigate and analyze the characteristics of Meridian Sinew (Jingjin) syndrome in patients with whiplash-associated disorders (WAD). METHODS: From August 2010 to September 2011, 313 WAD cases from New York and California states were collected. The survey mostly collects the information of "Sinew Knotted Points" and symptoms of four types of Meridian Sinew differentiation-Taiyang, Shaoyin, Shaoyang and Yangming. RESULTS: Among the cases which are on the average of medium injury level, the higher frequency of "Sinew Knotted Points" tenderness were found on Jianwaishu (SI 14), Jianzhongshu (SI 15), Tianchuang (SI 16), C3-6 Spinous Process, Dazhui (GV 14), Fengchi (GB 20), Tianliao (SJ 15) and Tianding (LI 17). The most commonly presented symptoms were widespread spasm and tenderness in the neck (Taiyang), difficulty in lateral flexion (Shaoyang), problems of extension and flexion (Taiyang), and stiffness and pain during neck movement (Yangming). Among the cases, 237 cases (75.72%) were related to Taiyang Meridian Sinew syndrome, 82 cases (26.20%) to Shaoyin syndrome and 175 (55.91%) and 176 (56.23%) cases to Shaoyang and Yangming syndrome respectively. The most of cases presented in a combination format. The syndrome distribution under Grade I, II and III reflected that more combination of the Meridian Sinew syndromes in the whiplash injury patients which is resulted from more severity of injury. CONCLUSION: It is practical to identify the location of abnormality through Meridian Sinew differentiation, considering both "Sinew Knotted Points" tenderness and corresponding symptoms, for the local neck symptoms of WAD.