Clinical efficacy of Buzhong Yiqi decoction in the treatment of hospital-acquired pneumonia with multi-drug resistant bacteria: a prospective, randomized, multicenter controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of Buzhong Yiqi decoction (, BZYQ) in the treatment of hospital-acquired pneumonia (HAP) with multi-drug-resistant bacteria (MDRB). METHODS: This 28-day study was conducted at 5 clinical centers in Shanghai. The eligible patients were randomly assigned (1:1) into the intervention group (BZYQ plus conventional Western Medicine therapy) and control group (conventional Western Medicine therapy). The primary outcomes were the clinical response, clinical pulmonary infection score (CPIS), and microbiologic response. The secondary outcomes were the 28-day all-cause mortality (ACM), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, ventilator weaning rate, length of mechanical ventilation (MV), length of hospital stay, and changes of infection indicators. RESULTS: Altogether 83 subjects in the intervention group and 85 subjects in the control group were analyzed. The clinical success rate (48.2%) and the pathogen eradication rate (59.0%) of the intervention group were all better than those of the control group (32.9% and 38.9%, respectively) with statistically significant differences (<0.05). The CPIS score of the intervention group (8.9 ± 1.7) was lower than that of the control group (9.6 ± 2.5) (<0.05). The length of MV in the intervention group [(13.7 ± 6.4) d] was significantly shorter than that of the control group [ (17.2 ± 7.2) d] (<0.05). The 28-day ACM of the intervention group (13.33%) was lower than that of the control group (21.2%) with no statistically significant difference (>0.05). The differences between two groups in ventilator weaning rate, length of hospital stay, and APACHE Ⅱ score were not statistically significant (> 0.05). The intervention group displayed decreases in white blood cell count, C-reactive protein, neutrophil percentage, and procalcitonin at day 28 compared with baseline (<0.05). No serious adverse events occurred in either group during the 28-day follow-up. CONCLUSION: BZYQ may be an effective therapeutic option for the management of HAP with MDRB.

Consensus on diagnostic criteria for deficiency syndrome in hypertension: a modified Delphi study.

OBJECTIVE: To reach consensus on the diagnostic criteria for deficiency syndrome in hypertension (YDSH) patients by a modified Delphi method. METHODS: Our study was consistent with T/CACM 1032-2017. The methodology of RAND/UCLA appr-opriateness was used to develop consensus guidance statements. A nationwide panel of experienced clinical experts from 19 provinces was constructed. These experts were all prominent in Traditional Chinese Medicine (TCM) of cardiovascular diseases. This con-sensus process consisted of two rounds of ques-tionnaires and a final round of consultation to analyze the weight score of each item. Moreover, the data extraction process is carried out independently by third-party researchers (LIANG Junya, SUN Yang, and DU Xiaona). When there is disagreement in all three rounds, the expert panel group (odd number) are invited to vote, and the one with more votes wins. In the questionnaires, participants were asked to rate the appropriateness of each syndrome item using a nine-point Likert scale. The consensus was defined as a panel median rating 1-3 or 7-9 without disagreement. And then the diagnostic criteria of YDSH were formed according to the weight score in the final round. RESULTS: Twenty-eight experts (84.8%) participated in the first round, and thirty-one (93.9%) finished the second round. After two rounds, the consensus of YDSH was reached on 11 items (25.6%), including symptoms, signs, and pulse condition. Twenty-one experts (63.6%) com-pleted the final round in which they used a grading system for each item. Red tongue with scanty fur had the highest weighting (22.8%), followed by heat in the palms and soles (20.1%). CONCLUSIONS: The consensus-based diagnostic criteria for YDSH, formed by a modified Delphi method, can be widely incorporated in TCM. A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our YDSH criteria.

Tongue and pulse features of 668 asymptomatic patients infected with the severe acute respiratory syndrome coronavirus 2 omicron variant in Shanghai.

OBJECTIVE: To characterize the tongue and pulse manifestations in asymptomatic coronavirus disease 2019 (COVID-19) cases in Shanghai. METHODS: We conducted a clinical study of 668 patients with asymptomatic infections in which we analyzed the tongue and pulse features in the Shanghai New International Expo Center mobile cabin hospital. The medical records of the patients, including tongue color, tongue coating, and pulse manifestations, were reviewed by healthcare workers. RESULTS: In total, 668 COVID-19 cases were included in the study. Patient age ranged from 5 to 96 years, with a median of 44.0 (IQR 33.0-53.0) years. Among the patients, 6.14% had comorbidities. The most common comorbid condition was diabetes (1.65%), followed by hypertension (0.89%), coronary heart disease (0.89%), thrombotic diseases (0.89%), congestive heart failure (0.60%), and stroke (0.45%). Pink-red (75.4%) was the most common tongue color, followed by red (23.4%) and pale red (1.2%). Tongue coating color and thickness were classified as white fur (9.28%), thin and yellow fur (48.65%), white greasy fur (8.98%), yellow greasy fur (24.70%), and less coating (8.39%). In addition, a large number of patients ( 300, 44.91%) presented superficial and rapid pulses, and 250 patients (37.4%) exhibited a slippery pulse. CONCLUSION: Our preliminary results showed that wind, heat, and dampness were the main etiologies of the severe acute respiratory syndrome coronavirus 2 Omicron (B.1.1.529) variant infection in traditional Chinese medicine. Furthermore, the main symptoms of the disease may be wind-heat invading the lung syndrome or damp-heat with the exuberance of virulence syndrome, which is of most significance in COVID-19 treatment.