Prophylactic Epidural Blood Patch or Prophylactic Epidural Infusion of Hydroxyethyl Starch in Preventing Post-Dural Puncture Headache - A Retrospective Study.

BACKGROUND: Post-dural puncture headache (PDPH) is particularly likely to happen in patients under obstetric care due to an unintentional dural puncture (UDP). There is as yet no ideal strategy for preventing UDP-induced PDPH. OBJECTIVES: The primary objective of this study was to assess whether a prophylactic epidural blood patch (EBP) or prophylactic epidural infusion of hydroxyethyl starch (HES) is effective in preventing PDPH for parturients with UDP compared with conservative treatments. STUDY DESIGN: Retrospective analysis from a single center's inpatient data. SETTING: Department of Anesthesiology at a single center. METHODS: A retrospective study was conducted of a single center's inpatient data from January 2017 through March 2020. The study included parturients with UDP during neuraxial anesthesia. The interventions of UDP included conservative treatment, prophylactic EBP, and prophylactic epidural infusion of HES. The incidence of PDPH, the use of intravenous aminophylline, therapeutic EBP, symptom onset, duration of headache, and duration of hospital stay were compared. RESULTS: A total of 85 patients were analyzed. The incidences of PDPH were 84%, 52.6% and 54.5% with conservative, prophylactic EBP, and prophylactic epidural HES treatments, respectively. Compared with the conservative treatment, prophylactic EBP and prophylactic epidural HES treatment significantly reduced the incidence of PDPH (P < 0.05). No significant difference was found between the prophylactic EBP and prophylactic epidural HES groups. Compared with the conservative treatment group, therapeutic EBP was significantly less used in the prophylactic EBP and prophylactic epidural HES groups (P < 0.05). Prophylactic EBP shortened the length of hospital stay of parturients with UDP (P < 0.05) while prophylactic epidural HES showed no statistical difference compared with conservative treatment. No severe complications, such as central nervous system and puncture site infection or nerve injury, were found in those patients. LIMITATIONS: Retrospective nature and single center data with a relatively small sample size. CONCLUSIONS: Prophylactic management with EBP and epidural infusion of HES has an effect in preventing the occurrence of PDPH; prophylactic EBP significantly shortened hospital stay length in parturients with UDP. KEY WORDS: Unintentional dural puncture, epidural blood patch, hydroxyethyl starch, post-dural puncture headache, parturient.

IL-17A and TNF-α inhibitors induce multiple molecular changes in psoriasis.

Adalimumab and secukinumab are commonly used for moderate to severe psoriasis vulgaris (PV). Although distinct individual responses to and impaired effectiveness of these biological agents occur occasionally, little is known about the underlying reasons. Here, we report a proteomic analysis of psoriatic lesions from patients treated with these drugs using data-independent acquisition mass spectrometry (DIA-MS). Thousands of differentially expressed proteins (DEPs) changed over 12 weeks of treatment. Network analysis showed that DEPs could interact and induce transformation in matrix components, metabolic regulation, and immune response. The results of parallel reaction monitoring (PRM) analysis suggested that S100s, STAT1, KRT2, TYMP, SOD2, HSP90AB1, TFRC, and COL5A1 were the most significantly changed proteins in both groups. There was a positive association between the Psoriasis Area and Severity Index (PASI) score and three proteins (TFRC, IMPDH2, KRT2). Our study findings suggest that inhibition of IL-17A and TNF-α can induce changes in multiple molecules in psoriatic lesions and have an overlapping influence on the immune response and process through direct or indirect effects.

Tripartite Motif-Containing 44 is Involved in the Tumorigenesis of Laryngeal Squamous Cell Carcinoma, and its Expression is Downregulated by Nuciferine.

Tripartite motif-containing 44 (TRIM44) was reported to be involved in the tumorigenesis of several tumors, but its function in laryngeal squamous cell carcinoma has not been investigated yet. In the present study, we aimed to elucidate the function of TRIM44 in laryngeal squamous cell carcinoma, and identify the compounds which could inhibit TRIM44 expression. Our results showed that TRIM44 was upregulated in tumor tissues and cell lines of laryngeal squamous cell carcinoma. Knockdown of TRIM44 significantly inhibited cell growth of laryngeal squamous cell carcinoma by suppressing TLR4, phosphorylated AKT and phosphorylated NF-κB p65 expression in vitro. Moreover, TRIM44 knockdown inhibited tumor growth in nude mice, which further suggested that TRIM44 exerted oncogenic activity in laryngeal squamous cell carcinoma. Interestingly, it was found that nuciferine significantly inhibited the mRNA levels of TRIM44 after screening a small natural compound library. Our further studies showed nuciferine markedly downregulated the protein levels of TRIM44 and its substrate TLR4 in a concentration-dependent manner in laryngeal squamous cell carcinoma cells. Moreover, the activation of downstream kinases of TLR4 such as AKT signaling pathway was also inhibited by nuciferine. Additionally, nuciferine markedly inhibited cell survival of laryngeal squamous cell carcinoma in a concentration-dependent manner. In contrast, TRIM44 overexpression significantly reduced the cytotoxicity of nuciferine in laryngeal squamous cell carcinoma cells. In conclusion, this study indicated that inhibiting TRIM44 would be a useful strategy for the treatment of laryngeal squamous cell carcinoma, and nuciferine could be a potential chemical applicated in the therapy of laryngeal squamous cell carcinoma.

[Study of drug intervention in diversity changes of TCRVbeta gene in AIDS patients with incomplete immune reconstitution].

OBJECTIVE: To discuss the drug intervention in diversity changes of TCRVbeta gene in AIDS patients with incomplete immune reconstitution. METHOD: PBMCs were isolated from 37 cases of AIDS patients failure to immune reconstitution before and after treatment with immune 2 and 15 cases of HIV negative healthy donors. The human gene TCRVbeta CDR3 diversity quantitative detection reagent box were used, and mapped the distribution of gene scanning and calculated different CDR3 fragme of each Vbeta family size. RESULT: Compared with the normal group, there appeared some single or oligoclonal amplification of Vbeta CDR3 region in the patients, which were improved or recovered after treatment. Among them, D value of four families (9, 11, 21, 22 ) decreased after treatment in both groups. The decrease in family 21 and 22 was significant (P < 0.05) in treatment group compared with the control group. And family 18 was decreased in treatment group and increased significantly in control group (P < 0.05). CONCLUSION: Study of the mechanism showed oligoclonal of TCRVbeta family can get recovery in some degrees after treated by Immune 2 plus HAART, suggesting that the medicine may promote T-cell receptor gene rearrangement, helping immune cells to effectively identify the virus to reduce T-cell apoptosis.

[Diversity changes of TCRVbeta gene in AIDS patients with incomplete immune reconstitution and influence of drug].

OBJECTIVE: To discuss the drug intervention in diversity changes of TCRVbeta gene in AIDS patients with incomplete immune reconstitution. METHOD: PBMCs were isolated from 37 cases of AIDS patients failure to immune reconstitution before and after treatment with Immune 2 and 15 cases of HIV negative healthy donors. The human gene TCRVbeta CDR3 diversity quantitative detection reagent box were used, and mapped the distribution of gene scanning and calculated different CDR3 fragme of each Vbeta family size. RESULT: (1) Gaussian distribution of TCRVbeta families in patients with incomplete immune reconstitution after one year of HAART, had been broken with the occurrence of the offset TCR lineage. After six months of treatment of traditional Chinese medicine combined HAART, the TCR lineage has been partially restored. (2) Evaluated by the D (distance) value calculated by a quantitative analysis software which the kit provides, there were no significant difference in D value change between the two groups, but with traditional Chinese medicine can reduce the data variability. (3) CD4+ T cell counts had a significant correlation (r = -0.772, P = 0.000) with TCRVbeta genetic diversity. CONCLUSION: Study of the mechanism showed oligoclonal of TCRVbeta family can get recovery in some degrees after treated by Immune 2 plus HAART, suggesting that the medicine may promote T-cell receptor gene rearrangement, helping immune cells to effectively identify the virus to reduce T-cell apoptosis.

[Applications of acupuncture in relieving AIDS-related symptoms].

AIDS is a serious threat to human health and has become a global public health problem. Highly active antiretroviral therapy (HAART) can effectively reduce AIDS mortality rate, but has limitations in improving the patient's symptoms and improve quality of life. The literatures about the therapeutic effect of acupuncture and moxibustion on HIV/AIDS were reviewed. The symptoms of HIV/AIDS and the procedures of treatments were analyzed. The acupuncture intervention on HIV/AIDS was investigated. It showed that the acupuncture intervention may markedly improve the condition of HIV/AIDS. From a clinical point of view, we discussed the acupuncture treatment of AIDS-related symptoms, effectiveness and safety evaluation. It may contribute to build a comprehensive treatment system in which acupuncture is dominated for HIV/AIDS.

Effect of Immune No. 2 on the immune reconstitution in patients with HIV/AIDS after highly active antiretroviral treatment: a randomized double blind placebo controlled clinical trial.

OBJECTIVE: To observe the Immune No. 2 (2) on the immune reconstitution in patients with human immunodeficiency virus or acquired immune deficiency syndrome (HIV/AIDS) after highly active antiretroviral therapy (HAART). METHODS: A randomized, double-blind, placebo-controlled clinical trial was designed. 233 patients failing immune reconstitution after HAART were randomly divided into treatment group (116 cases) and control group (117 cases), respectively using Immune No. 2 plus HAART and placebo combined with HAART for 6 months. CD4, CD45RA, CD45RO cell numbers, as well as the symptoms, signs and integral improvement rates were observed in order to evaluate the immune reconstitution efficiency. RESULTS: after the intervention for 1 month, the effective rate of the treatment group (18.97%, 22/116) was significantly higher than that of the control group (9.40%, 11/117) (P=0.02); 3 months after treatment, the effective rate of the treatment group (27.59%, 32/116) was no difference from that of the control group (22.22%, 26/117) (P=0.31); 6 months after treatment, the effective rate of the treatment group (34.48%, 40/116) was significantly superior to the control group (21.37%, 25/117) (P=0.02). CD4, CD45RA, CD45RO count of the treatment group was significantly higher than that of the control group (P<0.05). The total score of symptoms and signs in the treatment group was significantly lowered compared with the control group (P=0.02), and the improvement of fatigue, muscle and joint pain, pruritus and shortness of breath in the treatment group was better than the control group (P<0.05). CONCLUSION: Immune No. 2 can effectively improve the numbers of CD4 cells and its subgroups, as well as the main clinical symptoms and signs of patients after HAART, thereby promoting the immune reconstitution.

Fighting against acquired immunodeficiency syndrome with Chinese medicine: a perspective from China.

Continuing expansion of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) pandemic has been recognized as an exceptional challenge to global health. Taking highly active antiretroviral treatment (HAART), a confirmed effective treatment, has its limitations. While a much cheaper and potential treatment-the Chinese medicine (CM) has not been paid enough attention from the worldwide. We explained the CM viewpoints about pathology and etiology to answer some questions about whether and how CM can treat AIDS. Some herbal formulae and their targeted patterns and common symptoms were also introduced. Chinese government has realized the important role of CM as an independent therapy for early management, bolstering immune-system functions depressed by HIV, and has funded large randomized double-blind controlled clinical trials to more accurately assess the benefits, and valued the fundamental research to establish a quantitative standardization of pattern diagnosis. Researchers of CM are looking for cooperation with all the world's top experts in the areas of AIDS and immunity to strive for victories in the fight against AIDS.

Thoughts on intervention in HIV/AIDS with traditional Chinese medicine.

HIV/AIDS has become a worldwide pandemic and highly active antiretroviral therapy (HAART) is the only generally recognized effective therapy at present. However, various unresolvable problems appear with the widespread use of HAART. Traditional Chinese Medicine shows good efficacy for intervention in HIV/AIDS and could become an effective treatment option.

[On the concept of health in traditional Chinese medicine and its characteristics and advantages].

There are abundant systematic concepts of health and the wisdom of life-cultivation in traditional Chinese medicine (TCM), not only including the connotation of modern health, but also with many of its own characteristics. The health concept of TCM includes the holistic view of unison between man and universe, the harmonious unity of fusion of shape and soul, the people-oriented view of values and the balance of qi-blood-yin-yang in the human body. The characteristics and advantages of TCM for maintaining health consist of prevention, emotion regulation, to pay great attention to Upright Qi and obeying nature. To take full advantage of the health concept and regulation methods of TCM, to further study and spread it will promote and make great contributions to human health.

Effect of Yiqi Yangyin Decoction on the quality of life of patients with unstable angina pectoris.

OBJECTIVE: To observe the effect of Yiqi Yangyin Decoction (, YQYYD) on the quality of life (QOL) of patients with unstable angina pectoris (UAP). METHODS: A total of 108 patients with UAP of qi-yin deficiency syndrome confirmed by coronary angiography were enrolled and assigned to the treated group (treated with YQYYD and conventional therapy of Western medicine) and the control group (treated with conventional therapy of Western medicine), by the use of the PROC PLAN of the SAS 6.12 software, in a prospective, randomized, controlled design. The clinical total effective rate, symptom score, QOL scale [Seattle Angina Questionnaire (SAQ)] and incidence of important clinical events were defined as the observation indices to evaluate the interventional effect of YQYYD on the QOL of patients with UAP of the qi-yin deficiency syndrome. RESULTS: During the study, three cases dropped out in the treated group, one case dropped out in the control group, and 104 cases, including 51 cases in the treatment group and 53 cases in the control group, finished the trial. After four weeks of treatment, the total clinical effective rates in the treated group and the control group were 80.4% and 75.5% respectively, and there was no obvious difference between them (P>0.05). However, the symptom score of the treated group (9.31 + or - 2.02) was significantly lesser than that of the control group (11.62 + or - 3.04, P<0.05), and the total score of the QOL scale of the treated group (68.76 + or - 5.74) was significantly higher than that of the control group (61.06 + or - 3.31, P<0.01). Among those in the treated group physical limitation, angina stability, angina frequency, and treatment satisfaction were significantly ameliorated when compared with the control group after treatment (P<0.05, P<0.01). The incidence of important clinical events in the treated group (3.9%) was lower than that in the control group (5.7%) during the 8-month follow-up period, but the difference was insignificant (P>0.05). CONCLUSION: YQYYD could improve the clinical symptoms of patients with UAP of qi-yin deficiency syndrome and greatly improve their QOL.

[Immune reconstitution related factors in patients with HIV/AIDS].

Immune reconstitution could be found in part of HIV/AIDS patients after receiving highly active anti-retroviral therapy (HAART). Its influencing factors are very complex. Many factors, such as the demographic factor, stage of HIV disease, pattern of therapy, sort of co-infections, baseline of CD; T-cell count, abnormal immune activation, related immune phenotype, and virologic factors, all could influence the immune reconstitution. In view of Chinese medline (CM) may play a positive role in this process, the clinical evidences for above-mentioned factors were summed up briefly in this paper for providing reference to the future studies on immune reconstitution with intervention of CM.

[Correlation between syndrome factor combination and cardiac function as well as blood-lipid in coronary heart disease].

OBJECTIVE: To discuss the distribution laws of traditional Chinese medicine (TCM) syndrome factor and their combination in coronary heart disease (CHD), and to study the correlation between the TCM syndrome factor combination and cardiac function as well as blood-lipid. METHODS: The parameters of the cardiac function of 300 patients with a final diagnosis of CHD by coronary angiography were measured by echocardiography, and the levels of blood lipids in the CHD patients were detected. An analysis of the correlation was done between the TCM syndrome factor combination and cardiac function as well as blood-lipid in CHD. RESULTS: The TCM syndrome factor combinations of CHD were blood stasis due to qi deficiency, qi and yin deficiency, intermingled phlegm and blood stasis, and yang deficiency and blood stasis. The ejection fraction of CHD patients with yang deficiency and blood stasis was markedly decreased. The levels of triglyceride and low-density lipoprotein cholesterol in CHD patients with intermingled phlegm and blood stasis were markedly increased, and the level of triglyceride in CHD patients with qi and yin deficiency was markedly increased too. CONCLUSION: The treatment of CHD should aim directly at the symptoms and causes. It is also proved that some compound traditional Chinese herbal medicines for supplementing qi and activating blood circulation, nourishing yin and resolving phlegm, and activating yang should be used in treatment of CHD. In cases of CHD with low cardiac function, particular emphasis should be laid on activating yang and blood circulation, while in cases of CHD with blood-lipid disturbance, particular emphasis should be laid on resolving phlegm and activating blood circulation, replenishing qi and nourishing yin.

[Studies on the alkaloids from the herb of Corydalis adunca].

OBJECTIVE: To study the alkaloid constituents of Corydalis adunca. METHOD: The constituents were isolated on silica gel column and their structures were elucidated by IR, NMR, MS data. RESULT: Eight alkaloid compounds were isolated from alcohol extracts of the herb of C. adunca, and identified as dihydrosanguinarine (I), tetrahydrocolumbamine (II), 1,2,3,4-tetrahydro-7-methoxy-1-[(4-methoxy)phenyl]methyl-8-quinolinol (III), protopine (IV) and 6-acetonyl-5,6-dihydrosanguinarine (V). CONCLUSION: Five compounds were isolated from C. adunca for the first time.

[Studies on the alkaloids from herb of Corydalis adunca].

OBJECTIVE: To study the alkaloid constituents of Corydalis adunca. METHOD: The constituents were isolated on silica gel column and their structures were elucidated by IR, NMR, MS data. RESULT: Four alkaloid compounds were isolated from alcohol extract of the herb of C. adunca, and identified as tetrahydropalmatine, 1, 2, 3, 4-tetrahydro-6-methoxy-1-(4'-methoxyphenyl) methyl-7-isoquinolinol, coptisine and palmatine. CONCLUSION: Four compounds were isolated from C. adunca for the first time.

[Chemical components of essential oils from the herb of Ligularia virgaurea].

OBJECTIVE: To provide the foundation for reasonable utilization by analyzing the essential oils of Ligularia virgaurea. METHOD: The essential oils were extracted by using steam distillation and separated with GC capillary columns. The components were quantitatively determined with normalization method, and were identified with GC-MS. RESULT: 41 components were identified, which took up 72.73% of the essential oils. CONCLUSION: The main components of essential oils were 4-methyl-1-(1-methylethyl)-3-cyclohexen-1-ol(14.369%), crotonic acid, 2,2-dimethyl-butanoic acid, 1-methyl-3-(1-methylethyl)-benzene, (1s-endo)-1,7,7-trimethyl-bicyclo[2,2,1]heptan-2-ol, trans-1-methyl-4-(1-methylethyl)-2-cyclohexen-1-ol, alpha-cadinol and alpha,alpha,4-trimethyl-3-cyclohexene-1-methanol.

Phase separation in two-dimensional binary fluid mixtures: spontaneous pinning effect.

The dynamics of phase separation, under asymmetric quench, is studied for binary mixtures by molecular dynamics simulations. We consider two kinds of systems, i.e., the small molecular liquid mixture and the flexible chain blend. The domain growth is found to be dependent crucially upon the relative composition of the mixture. For a near symmetric quench with volume fraction not far away from the critical value, we find that the domain growth is obviously slowed down (the spontaneous pinning effect) when the phase-separating structure undergoes the percolation-to-cluster transition. However, as the volume fraction of the minority phase is decreased, a pinning-depinning transition of the domain growth is observed for certain asymmetric quenches, due to the correlated motion of droplets. For sufficiently asymmetric quenches where the volume fraction of the minority phase is low, the domain growth is suppressed at late stages for the flexible polymer blend, in contrast to the fast growth for the small molecular system. The results are in good agreement with previous studies, and confirm the possibility of the intermittent or final pinning of phase separation for isolated droplets structure.

The relationship of lmp2 and DR3 genes with susceptibility to type I diabetes mellitus in south China Han population.

AIM:To study the relationship of lmp2 and DR3 genes with type I diabetes mellitus.METHODS:lmp2 genotypes and DR3 were identified in 68 patients with type I diabetes mellitus (I -DM) and 71 healthy controls. Then,I -DM patients and controls were respectively allocated into DR3-positive and DR3-negative groups. The frequencies of lmp2 and DR3 gene in random subjects, and lmp2 genotypes in DR3 matched subjects were compared between I -DM patients and controls. At the same time, I DM patients were divided into 3 groups based on the onset age of diabetics:group A < = 14 years, group B 15-30 years and group C > = 31 years.RESULTS:The frequency of DR3 in I-DM patients was significantly higher than that in controls (47% vs 21%, P < 0.005), and it was significantly higher in group A than that in group B+C (70% vs 36%, X(2) = 7.07, P < 0.01). There was a significant difference among groups with different onset age of diabetics (X(2) = 8.19, rp = 0.33, P <0.05). In random subjects, the frequency of lmp2-R/R in I -DM patients was lower (43% vs 61%, P <0.05)and lmp2-R/H higher (53% vs 28%, P<0.05) than that in controls, and there was no significant difference among groups with different onset age of diabetics.In DR3-positive subjects, the frequency of lmp2-R/R in I-DM patients was lower (47% vs 87%, P<0.05) and lmp2-R/H higher (47% vs 13%, P <0.05) than that in controls. In DR3-negative subjects,the frequency of lmp2-R/H in I -DM patients was higher than that in controls (58% vs 32%, P <0.01), but the frequency of lmp2-R/R and lmp2-H/H was not significantly different between these two groups.CONCLUSION:DR3 gene may be one of the susceptible genes of I-DM,and significantly related to the onset age of diabetics, and the persons with DR3 may have an younger onset age of diabetes.The lmp2-R/R may be the protective genotype of I-DM, and lmp2-R/H the susceptible genotype. These were not affected by DR3 gene. lmp2 genotypes were not related with the onset age of diabetics.