The fenrou zhijian theory in The Inner Canon of Huangdi and the stratified treatment of painful bi syndrome of meridian tendons / 中国针灸

The fenrou zhijian is defined as potential gap between different layers in the three-dimensional network structure formed by the twelve meridian tendons. Various pathological changes of the meridian tendons lead to the adhesion and closure of fenrou zhijian, causing abnormal mechanical conduction of the meridian tendon system, which in turn leads to painful bi syndrome of meridian tendons. As such, restarting the fenrou zhijian is the key to acupuncture treatment for painful bi syndrome of meridian tendons. Under the guidance of musculoskeletal ultrasound, the level and the angle of needle insertion of acupuncture at fenrou zhijian could be accurately controlled, the efficacy of acupuncture is improved.

Interpretation of therapeutic effect of / 中国针灸

Given that the biomechanical theory cannot well explain the therapeutic effect of

Correlation analysis between the surface electromyography and muscle fiber types of the core muscle group in the patients with myofascial pain syndromes / 中国骨伤

OBJECTIVE@#To detect the core muscle group in the patients with myofascial pain syndromes(MPS) by using the surface electromyography; to detect the distribution of muscle fiber type by the analysis of the median frequency and the slope of the median frequency.@*METHODS@#From October 2017 to March 2018, there were 100 patients with the MPS, including 45 males and 55 females; the average age was 48.5 years old, ranging from 29 to 76 years old. There were 40 cases of left back pain and 60 cases of right back pain. The course of illness was more than 6 months. Another 40 healthy patients without pain in the waist were included in the control group, 20 males and 20 females; the average age was 47.3 years old, ranging from 29 to 76 years old. All the patients had different degrees of back pain and muscle stiffness, which were diagnosed as lumbar fasciitis by clinical and imaging examination. Surface electromyography was used to measure the characteristics of the lumbar core muscles (multifissions, iliocostal muscles, and longest muscle) of the three groups in the Biering-Sorensen testing, such as median frequency(MF) and absolute slope of median frequency (MFs).@*RESULTS@#The MF values of the multifidus muscle in the three groups were as follows:the left side of the non-pain group was 133.88±26.61, and the right side was 131.39±29.81; left side of lift side pain group 117.29±10.93, right side 133.70±17.81; in the right pain group, the left side was 131.36±17.37, and the right side was 118.28±13.57. The MF values of the iliocostal muscle in the three groups were:106.94±28.01 on the left side of the non-pain group, 114.68±18.96 on the right side; left side of lift side pain group 93.95±11.17, right side 107.60±27.86; in the right pain group, the left side was 105.93±15.52, and the right side was 97.27±19.27. The MF values of the longest muscle in the three groups were:109.24±26.20 on the left side of the non-pain group, 112.58±17.70 on the right side. Left side of left side pain group 95.58±10.83, right side 108.79±26.39; in the right pain group, the left side was 106.50±17.98, and the right side was 98.20±11.16. The MFs values of the multifidus muscle in the three groups were:0.221±0.109 on the left side of the non-pain group, and 0.259±0.169 on the right side; left side of left side pain group 0.318±0.184, right side 0.210±0.159; in the right pain group, the left side was 0.258±0.169, and the right side was 0.386±0.166. The MFs values of the iliocostal muscles in the three groups were:0.241±0.158 for the left side of the non-pain group, and 0.238±0.128 for the right side. Left side of left side pain group 0.330±0.208, right side 0.252±0.171; in the right side pain group, left side 0.249±0.150, right side 0.343± 0.144. The MFs values of the longest muscle of the three groups were:0.244±0.252 on the left side of the non-pain group, and 0.210±0.128 on the right side; left side of left side pain group 0.348±0.255, right side 0.241±0.224; in the right pain group, the left side was 0.239±0.155, and the right side was 0.334±0.233. There were no statistically significant differences in MF and MFs values of the left and right lumbar multifidus muscle, iliocostal muscle and longest muscle in the non-pain group(>0.05). MF values of the pain side multifidus muscle, iliocostal muscle and longest muscle in the lumbago group were lower than those in the non-pain group(<0.05). MFs values of the painful side multifidus muscle, iliocostal muscle and longest muscle in the low back pain group were higher than those in the non-pain group(<0.05).@*CONCLUSIONS@#The muscle fatigue degree of the back muscle in the pain side of patients with MPs is decreased, and the muscle fiber type is dominated by II muscle fiber.

Efficacy and safety of domestic leuprorelin in girls with idiopathic central precocious puberty: a multicenter, randomized, parallel, controlled trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In central precocious puberty (CPP), the pulse secretion and release of gonadotropin-releasing hormone (GnRH) are increased due to early activation of the hypothalamic-pituitary-gonadal axis, resulting in developmental abnormalities with gonadal development and appearance of secondary sexual characteristics. The CPP without organic disease is known as idiopathic CPP (ICPP). The objective of the study was to evaluate the clinical efficacy and safety of domestic leuprorelin (GnRH analog) in girls with ICPP.</p><p><b>METHODS</b>A total of 236 girls with ICPP diagnosed from April 2012 to January 2014 were selected and were randomized into two groups. One hundred fifty-seven girls in the test group were treated with domestic leuprorelin acetate, 79 girls in the control group were treated with imported leuprorelin acetate. They all were treated and observed for 6 months. After 6-month treatment, the percentage of children with peak luteinizing hormone (LH) ≤3.3 U/L, the percentage of children with peak LH/peak follicle stimulating hormone (FSH) ratio <0.6, the improvements of secondary sexual characteristics, gonadal development and sex hormone levels, the change of growth rate of bone age (BA) and growth velocity, and drug adverse effects between two groups were compared.</p><p><b>RESULTS</b>After the treatment, the percentage of children with a suppressed LH response to GnRH, defined as a peak LH ≤3.3 U/L, at 6 months in test and control groups were 96.80% and 96.20%, respectively, and the percentage of children with peak LH/FSH ratio ≤0.6 at 6 months in test and control groups were 93.60% and 93.70%, respectively. The sizes of breast, uterus and ovary of children and the levels of estradiol (E 2 ) were significantly reduced, and the growth rate of BA was also reduced. All the differences between pre- and post-treatment in each group were statistically significant (P < 0. 05), but the differences of the parameters between two groups were not significant (P > 0.05).</p><p><b>CONCLUSIONS</b>Domestic leuprorelin is effective and safe in the treatment of Chinese girls with ICPP. Its effectiveness and safety are comparable with imported leuprorelin.</p>

Effects of electroacupuncture at "Yishu" (EX-B 3) on the relative hormones of HPA axis in rats with type-2 diabetes mellitus / 中国针灸

<p><b>OBJECTIVE</b>To observe the intervention effects of electroacupuncture at "Yishu" (EX-B 3) on rats with type-2 diabetes mellitus (T2DM), so as to provide experiment references for acupuncture to treat T2DM.</p><p><b>METHODS</b>Among seventy male Wistar clean-grade rats, 8 rats were randomly selected into a control group; the rest rats were made T2DM model. Fifty-two rats which were successfully made T2DM model, according to randomized block method, were divided into a model group (10 rats), a medication group (10 rats), an electroacupuncture at "Shenshu" (BL 23) group (11 rats), an electroacupuncture at "Pishu" (BL 20) group (10 rats) and an electroacupuncture at "Yishu" (EX-B 3) group (11 rats). Seven days after successful establishment of model, the rats in the model group were fixed in the self-made rat bag without receiving any treatment; the rats in the medication group, according to body mass (10 mL/kg), were treated with intragastric administration of glimepiride; the rats in all the electroacupuncture groups were treated with electroacupuncture at "Shenshu" (BL 23), "Pishu" (BL 20) and "Yishu" (EX-B 3), respectively. The continuous wave was selected with a frequency of 15 Hz and a current intensity of 4 to 6 mA. The treatment was given 20 min per treatment, once a day, 5 treatments per week for continuous 4 weeks. Before the establishment of model and continuous 4 weeks after the intervention, blood samples were collected from rats' caudal vein, and fasting blood glucose (FBG) was measured with FBG device each week. After the last intervention, the rats were killed and hypothalamus, pituitary and adrenal gland were collected. The colorimetric method was applied to measure the contents of triglyceride (TG), cholesterol (TC), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C); radioimmunoassay was used to test the contents of glycated serum protein (GSP), fasting insulin (FINS), corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and cortin (CORT).</p><p><b>RESULTS</b>Four weeks after the intervention, except that the rat's body mass in the normal group continued to increase, body mass in the model group, medication group and each electroacupuncture group were significantly reduced (P<0.01, P<0.05). Compared with the model group, the FBG in the electroacupuncture at "Pishu" (BL 20) group and electroacupuncture at "Yishu" (EX-B 3) group were obviously reduced (P<0.05, P<0.01); FBG in the electroacupuncture at "Yishu" (EX-B 3) group was lower than that in the medication group and electroacupuncture at "Shenshu" (BL 23) group (both P<0.05). The contents of TG, HDL-C and LDL-C in the electroacupuncture at "Yishu" (EX-B 3) group were reduced (P<0.05, P<0.01), the content of TG was significantly lower than that in the medication group and electroacupuncture at "Shenshu" (BL 23) group (both P<0.05), the content of LDL-C was significantly lower than that in electroacupuncture at "Shenshu" (BL 23) group (P<0.05). Insulin sensitivity index (ISI) in the medication group, electroacupuncture at "Pishu" (BL 20) group and electroacupuncture at "Yishu (EX-B 3)" group were evidently increased (P<0.05, P<0.01); ISI in the medication group was lower than that in the electroacupuncture at "Yishu" (EX-B 3) group (P<0.05). The content of CRH in the electroacupuncture at "Yishu" (EX-B 3) group was lower than that in the medication group and electroacupuncture at "Shenshu" (BL 23) group (P<0.05, P<0.01); the content of CORT in the electroacupuncture at "Yishu" (EX-B 3) group was lower than that in the medication group and electroacupuncture at "Pishu" (BL 20) group (both P<0.05).</p><p><b>CONCLUSION</b>Electroacupuncture at "Yishu" (EX-B 3) could reduce the level of CORT to improve the insulin resistance in rats with T2DM, improve insulin sensitivity index, regulate blood lipid metabolism and relieve the hyperactivity of the HPA axis.</p>

Analysis of clinical and genetic characteristics of 20 cases of children with Silver Russell syndrome / 中华儿科杂志

<p><b>OBJECTIVE</b>To improve the accuracy of the diagnosis of the disease on the basis of the clinical features and genetic characteristics of patients with Silver Russell syndrome (SRS).</p><p><b>METHOD</b>Patients diagnosed with SRS by Price criteria in 2006 to 2011 were reviewed for their clinical manifestations, physical signs, laboratory examinations and treatments.</p><p><b>RESULT</b>Twenty cases with SRS were 0.08-12.17 yr old. Fifteen were male and 5 were female. The clinical characteristics included more than 80% of cases had postnatal growth retardation 100% (20/20), craniofacial dysmorphism 100% (20/20), small for gestation age 95% (19/20), asymmetry and thinning of the face and/or limbs 90% (18/20), fifth finger clinodactyly 80% (16/20), BMI < -2 SDS 80% (16/20). Their height was obviously lagging behind in the bone age. HD SDS/average of bone retardation was 3.08. The two patients with the chief complaint of external genital abnormalities would have aggressive surgical treatment and they did not use the growth hormone (GH) treatment. Only six patients had used the GH treatment. GH treatment at a dose of 0.1 IU/(kg·d) used in 2 cases achieved a growth velocity (GV) 8 - 11 cm/yr but in another 2 cases < 5 cm/yr. In genetic study, 6 patients were found to have 11p15 low methylation, 1 had low and high methylation, 1 had duplication, no relation between clinical and methylation of 11p15 was found.</p><p><b>CONCLUSION</b>There were great variations of clinical features in SRS characterized by small for gestation age and/or postnatal growth retardation, craniofacial dysmorphism, asymmetry of the face and/or limbs or ultrafine limbs, fifth finger clinodactyly. Severely low BMI was seen and height was obviously lagging behind in the bone age. The findings of laboratory tests and imaging of SRS were not specific. Some of SRS had 11p15 imprinting defects. The treatment of SRS is mainly symptomatic.</p>

Blood glucose profile in children and adolescents in Beijing area / 中华儿科杂志

<p><b>OBJECTIVE</b>There are scant data about normal reference values of blood glucose (BG) in children. This study was conducted to learn the BG profile of children and adolescents in Beijing area.</p><p><b>METHOD</b>The population for survey was selected as a stratified cluster sample from 8 urban and 10 rural areas in Beijing. Fasting capillary blood glucose (FCBG) was determined in 19,593 children and adolescents aged 6 to 18 years in 4 urban and 3 rural areas using haemosaccharometer model II [Roche Diagnostic, (Shanghai) Ltd].</p><p><b>RESULTS</b>There were 1 9112 (97.5%) individuals with complete records, the mean age was 12.1 +/- 3.3 years (ranged from 6 to 18.9 years); 9514 (49.8%) were boys, 9598 (50.2%) were girls, 9792 were (51.2%) from urban areas and 9320 (48.8%) from rural areas. The average level of FCBG in boys was higher than that in girls (4.7 +/- 0.5 vs. 4.5 +/- 0.5, u = 28.0, P < 0.01). Among urban children, the trend of variation of FCBG was similar between boys and girls, the levels of FCBG increased with age, the peak of FCBG was reached at 12-13 years in urban girls, and from the age of 15 years, the level of FCBG declined. In boys, the FCBG level increased slowly from 13 years of age, there was no significant variation until 17 years old, and declined at the age of 18. Among suburban children, the trend of variation of FCBG was similar between boys and girls, both of them had two peaks, from 6 to 11 years old, FCBG of both boys and girls increased with age, and both reached the first peak at the age of 11 years. While at 13 years of age, there was an obvious drop in FCBG level. From 14 years of age on, there was a rise of FCBG in both boys and girls, and the second peak of FCBG was reached at 15 and 16 years of age in girls and boys respectively. The FCBG level of urban children was higher than that of rural children (4.7 +/- 0.5 vs. 4.6 +/- 0.5, u = 13.8, P < 0.01). The level of FCBG in overweight and obese children was higher than that of normal children. More boys, more obese and more urban children had abnormal FCBG.</p><p><b>CONCLUSIONS</b>The blood glucose level of children was associated with age, gender, obesity and district.</p>

Allgrove syndrome in the mainland of China: clinical report and mutation analysis / 中华儿科杂志

<p><b>OBJECTIVE</b>Allgrove syndrome is a rare autosomal recessive disorder characterized by the triad of adrenal insufficiency, achalasia and alacrima and many cases have multi-systems disorder: endocrine, gastrointestinal tract, eyes and nervous system. This syndrome is also known as achalasia-addisonianism-alacrima syndrome or triple A syndrome. Allgrove syndrome is now known to be caused by mutations of AAAS gene encoding the aladin protein. In the present paper, we report a Chinese mainland girl with Allgrove syndrome with mutations in the AAAS gene.</p><p><b>METHOD</b>The patient was a 7-year-old girl complained of coma and dark skin; she was treated as Addison disease for 2 years and had vomiting for 9 months before the second admission. Gene analysis was performed after extracting genomic DNA by amplification and sequencing of the specific fragments of AAA gene.</p><p><b>RESULTS</b>The patient was confirmed to have adrenal insufficiency at the age of 5 years and 6 months. During the second hospitalization, she was found to have a remarkable brisk reflexion, bilateral optic nerve atrophy, alacrima and achalasia besides ACTH resistance. The girl was born to consanguineous parents. Based on these findings, she was diagnosed as having Allgrove syndrome. Mutation analysis revealed a novel homozygous deletion of a single G, c.771delG, in exon 8 of the AAAS gene. This frame shift mutation was predicted to create a premature stop codon at locus 290, p.R258GfsX33, leading to a truncated and non-functioning aladin protein. Both the parents were heterozygous for the mutation.</p><p><b>CONCLUSION</b>The clinical manifestations and AAAS gene mutations analysis confirmed the diagnosis of Allgrove syndrome. Gene analysis indicated that this syndrome is an autosomal recessive inherent disorder. ALADIN is significant for the normal cell function. When compared with reported cases, it seems that there are no remarkable relation between gene mutation loci and clinical manifestations in Allgrove syndrome.</p>

The prevalence of diabetes in children and adolescents of Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the prevalence of Diabetes mellitus (DM) in children and adolescents and to describe the characteristics on age, gender and district distribution of schoolchildren, in Beijing.</p><p><b>METHODS</b>A cross-sectional screening program the fasting capillary blood glucose (FCBG) was carried out in 19,593 schoolchildren in 7 areas of Beijing from March to October, 2004. According to the WHO diagnostic criteria: DM was set as FCBG < or = 6.1 mmol/L, impaired fasting glucose (IFG) was set as 5.6 mmol/L < or = FCBG < 6.1 mmol/L.</p><p><b>RESULTS</b>The total aggregate age-adjusted prevalence rates of DM and IFG were 5.7 per thousand and 13.5 per thousand, respectively. The prevalence rates of DM and IFG in males were significantly higher than that in females (7.7 per thousand vs. 3.6 per thousand and 26.8 per thousand vs. 11.3 per thousand. DM X2 = 12.27, P = 0.0005; IFG X2 =47.29, P = 0.0000). Among seven districts, East District had the highest prevalence rates of DM and IFG, 8.9 per thousand and 27.4 per thousand (companied high obesity 28.68%) while Ping-Gu District having the lowest ones as 2.0 per thousand and 7.5 per thousand (obese 12.75%) respectively (X2 = 13.75, and X2 = 32.65, P = 0.0002 and P < 0.0001). The DM prevalence rates between districts ranged from 2.0 per thousand to 8.9 per thousand, X2 = 18.94, P = 0.004 and the IFG prevalence of districts ranged from 7.5 per thousand to 27.4 per thousand (X2 = 52.05, P < 0.0001). The prevalence rates of DM among different age groups increased with age, with the highest prevalence of IFG on the 10-14 age group. Among boys, the highest prevalence rates of DM and IFG fell in the 15-18 and 10-14 age groups respectively while the highest prevalence rates on both DM and IFG among girls were in the same age group 10-14.</p><p><b>CONCLUSION</b>The high prevalence rates on DM and IFG were seen in Beijing and showed significant discrimination on age, gender and district distribution. More developed urban district and males had a higher prevalence, companied by higher obesity prevalence. Age seemed to be a high risk factor on DM for boys while the puberty development seemed a high risk factor for girls.</p>

Relationship between serum high-sensitivity C-reactive protein and obesity and impaired glycose metabolism in children and adolescents / 中华儿科杂志

<p><b>OBJECTIVE</b>High-sensitivity C-reactive protein (hs-CRP) may predict the development of type 2 diabetes mellitus (T2DM), metabolic syndrome (MS) and cardiovascular diseases (CVD) in adult, but few reports on relevant studies in children are available. The present study aimed to understand possible correlation between serum hs-CRP levels and some factors of obese children and adolescents with or without impaired glycometabolism.</p><p><b>METHODS</b>Seventy obese children and adolescents (age 8 - 17 years) and 30 non-obese healthy controls (group 1, 20 boys and 10 girls, mean age 12.6 years) were enrolled into this study. The obese individuals were subdivided into two groups according to the results of oral glucose tolerance test: the obese subjects without IGR (group 2, 54 cases, 43 boys and 11 girls, mean age 11.3 years) and the obese subjects with impaired glycometabolism (group 3, 16 cases, 8 boys and 8 girls, mean age 12.8 years). The levels of serum parameters including hs-CRP, glucose, lipid, insulin, C-peptide and whole blood HbA1c were determined. SPSS 10.0 was used for statistical analysis.</p><p><b>RESULTS</b>(1) There was significant increase of serum hs-CRP level in obese children and adolescents, the median was 2.44 (0.01 - 14.6) mg/L; the level of control group was 0.1 (0.01 - 2.1) mg/L. (2) Some of the following parameters, such as fasting plasma glucose (FPG), triglyceride (TG), fasting insulin (FINS), C-peptide (Cp) and insulin resistance index (IRI), were found increased in group 2 and 3 as compared to group 1. When FPG and TG were still in normal range in group 2, the levels of hs-CRP and IRI were significantly higher than those in group 1, the level of hs-CRP was 2.4 (0.01 - 9.0) mg/L. While FPG and TG were abnormal in group 3, the level of hs-CRP was 2.6 (0.1 - 14.6) mg/L, but the difference had no statistical significance. (3) Pearson correlation analysis showed that there was a moderate correlation between serum hs-CRP and BMI (r = 0.414, P = 0.000). There was a low correlation between hs-CRP and waist circumference, hip circumference and waist to hip ratio (WHR). The correlation of serum hs-CRP with blood pressure, TG, cholesterol, high density lipoprotein-cholesterol (HDL-C), HbA1c, FPG, FINS and Cp had no significant deviation. (4) Multiple linear regression analysis showed that body mass index (BMI) was the only indicator which had correlation with hs-CRP.</p><p><b>CONCLUSION</b>(1) There may be a chronic low-grade inflammation and insulin resistance in obese children. (2) The level of hs-CRP might be independently correlated with BMI in children. (3) Hs-CRP and IRI elevated before FPG and TG did, which may suggest that the low-grade inflammation and insulin resistance may be a pathogenic base of DM rather than the outcome of it. (4) The elevation of hs-CRP may help predict impaired glucose and lipid metabolism.</p>