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Zishenwan， also known as Tongguanwan， is composed of three herbs：Anemarrhenae Rhizoma， Phellodendri Chinensis Cortex， and Cinnamomi Cortex， which thus is thought to be the representative formula to clear heat， purge fire， nourish Yin， and tonify Qi， and it is often used for treating anuresis and renal arthralgia. In recent years， this formula has become a commonly used combination of herbs and is used to treat diabetes （consumptive thirst disease） diagnosed with "lower consumption" syndrome. This article systematically reviewed the development of traditional Chinese medicine （TCM） theory for Zishenwan. Moreover， based on modern pharmacological research， the previous studies on the components of Zishenwan， the improvement of diabetes-related diseases by Zishenwan， and the relationship between the single herd of Zishenwan and the treatment of diabetes were summarized， and the chemical components and the mechanisms for treating diabetes by the three herbs were discussed. It is found that Zishenwan can alleviate diabetes and diabetic nephropathy by performing anti-inflammation， enhancing insulin sensitivity， and inhibiting pyroptosis of renal tubular epithelial cells. Three herbs in Zishenwan and several components of them， including mangiferin， timosaponins， berberine， jatrorrhizine， cinnamaldehyde， and cinnamic acid can ameliorate diabetes and maintain stable glycometabolism by a variety of mechanisms such as improving insulin resistance in insulin target tissues， suppressing inflammation， anti-oxidation， regulating lipid metabolism， enhancing insulin secretion， and regulating gut microbiota. This review provides a theoretical foundation and reference for subsequent studies on the mechanisms of the anti-diabetic effect of Zishenwan.
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Objective@#The aim of this study is to determine the accuracy of RSI and RFS in the diagnosis of hypopharyngeal reflux （LPR）, the scores of RSI and RFS were compared in different age groups. To explore the RSI and RFS scoring thresholds for diagnosis of LPR in different age groups. @*Method@#From January 2017 to March 2019, 258 patients with suspected LPR in our hospital outpatient clinic completed the RSI and RFS scales. According to their age, 258 patients with RSI>13 and RFS>7 were selected. They were divided into group A （18-<40 years, n=86）, group B （40-<60 years, n=107） and group C （≥60 years, n=65）. The diagnosis was confirmed by 24 h pH-metry. The diagnostic rate, RSI and RFS scores were compared among the three groups. ROC curve was used to analyze the optimal thresholds for the diagnosis of LPR by RSI and RFS scores. @*Result@#Among the three groups, group C had the highest diagnostic rate（93.85%）. There was no significant difference in RFS score among the three groups （P>0.05）, RSI score was significantly different （P<0.05）, RSI score of group A and group B was higher than that of group C （P<0.05）. According to ROC analysis, the best RSI cutoffs for diagnosing LPR in group C was 11, and the area under the ROC curve was 0.866. @*Conclusion@#The RSI score is a good criterion for the diagnosis of LPR. The diagnostic threshold of RSI in elderly patients is different from that in young patients. For elderly patients, the diagnostic threshold for the recommended RSI score is 11.
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The aim of this study is to determine the accuracy of RSI and RFS in the diagnosis of hypopharyngeal reflux （LPR）, the scores of RSI and RFS were compared in different age groups. To explore the RSI and RFS scoring thresholds for diagnosis of LPR in different age groups. From January 2017 to March 2019, 258 patients with suspected LPR in our hospital outpatient clinic completed the RSI and RFS scales. According to their age, 258 patients with RSI>13 and RFS>7 were selected. They were divided into group A （18-0.05）, RSI score was significantly different （<0.05）, RSI score of group A and group B was higher than that of group C （<0.05）. According to ROC analysis, the best RSI cutoffs for diagnosing LPR in group C was 11, and the area under the ROC curve was 0.866. The RSI score is a good criterion for the diagnosis of LPR. The diagnostic threshold of RSI in elderly patients is different from that in young patients. For elderly patients, the diagnostic threshold for the recommended RSI score is 11.
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Objective To evaluate the feasibility of using noninvasive ultrasonic cardiac output monitor USCOM velocity time integral (VTI) as the observation index of PLR.Methods This prospective study recruited 36 septic shock or acute pancreatitis patients from October 2014 to October 2016 in the resuscitation room and EICU of Peking Union Medical College Hospital.The change of VTI and plus pressure before and after PLR (⊿VTIplr and ⊿pp),and the change of VTI and stroke volume before and after 500 mL of volume expansion (⊿VTIve and ⊿SV) were recorded.Fluid response positive was defined as stroke volume increase more than 15％ after volume expansion.Results ⊿VTIplr was positively correlated with ⊿SV (Spearman correlation coefficient r=0.888,P＜0.01).The predicting value of⊿VTIve,⊿VTIplr and ⊿PP in fluid response were as follows:the sensitivity of ⊿VTIve in ＞15％ was 94.7％,the specificity was 94.1％,area under the ROC curve was 0.989;the sensitivity of⊿ VTIplr in ＞12％ was 84.2％,the specificity was 88.2％,area under the ROC curve was 0.916;and the sensitivity of⊿ PP in ＞10.5％ was 78.9％,the specificity was 88.2％,the area under the ROC curve was 0.870.Conclusions ⊿ VTIplr measured by USCOM before and after the PLR is a sensitive and specific index.It is better than the classic index ⊿ PP.⊿ VTIplr measured by USCOM is completely noninvasive,which has very good application prospect in the emergency department.
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Objective To compare the efficacy of two rapid lipid lowering methods as plasma exchange and insulin in the treatment of hyperlipidemic acute pancreatitis.Methods The clinical data of 98 patients with hyperlipidemic acute pancreatitis in Peking Union Medical College Hospital from January 2014 to December 2016 were retrospectively analyzed.All patients were divided into plasma exchange group (n =42) and insulin group (n=56) according to rapid lipid lowering method.Results There were no significant differences in the onset-to-treatment time,the proportion of patients with diabetes,the proportion of patients with pregnancy,the initial triglyceride level,Acute Physiology,Age and Chronic Health Evaluation l score and modified CT severity index score score and conditioning-test stimulus interval (CTSI) score between the plasma exchange group and the insulin group (P＞0.05).In addition,there were also no significant differences in the incidences of acute respiratory distress syndrome,acute kidney injury,shock and pancreatic abscess,and the proportion of moderate pancreatitis and severe pancreatitis,oral / jejunum nutrition tolerating start time,hospitalization time and mortality between the two groups (P＞0.05).The plasma exchange group had significantly less time to achieve the target triglyceride level and to reach normal free fatty acids level than the insulin group [(13.09±12.50) hvs.(46.92±20.92) h,t=3.291,P=0.001;(15.75±14.13) hvs.(73.21±38.49) h,t =3.291,P=0.001].The pancreatic pseudocyst incidence was significantly lower (7.14％ vs.23.21％,t =2.120,P=0.034),and the hospitalization cost was significantly higher [(81 794.92±33 719.69) yuan vs.(56 042.43±30 565.34) yuan,t =2.034,P =0.042] in the plasma exchange group than in the insulin group.Conclusions Both plasma exchange and insulin can rapidly lower blood lipids.Plasma exchange has certain advantages over insulin in lipid-lowering,for it is faster,and has lower incidence of pancreatic pseudocyst,thus can be applied in patients whose financial conditions permit.
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OBJECTIVE:To observe the efficacy and safety of different administration of dexamethasone in the treatment of se-cretory otitis media. METHODS:Data of 92 patients with secretory otitis media was retrospectively collected and divided into ob-servation group(43 cases)and control group(49 cases)by different administration. Observation group received 5 mg Dexametha-sone injection by injection in the eustachian tube in the assisted by video laryngoscope,once every 2 day. Control group received 5 mg Dexamethasone injection by injection in the eustachian tube,once every 2 day. 7-day was regarded as 1 treatment course. 1 more course for uncured patients,and no more than 4 courses. Clinical efficacy,and tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),IL-10 levels before and after treatment,and 1-year cumulative recurrence rate after cured and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was signifi-cantly higher than control group,1-year cumulative recurrence rate after cured was significantly lower than control group,the dif-ferences were statistically significant(P0.05). After treatment,TNF-α and IL-6 level in 2 groups were significantly lower than before, and observation group was lower than control group,the differences were statistically significant(P0.05). And there was no significant difference in the incidence of adverse reactions between 2 groups(P>0.05). CONCLUSIONS:The efficacy of dexamethasone by injection in the eustachian tube in the assisted by electron-nasopharyngolaryngoscopy is superior to auripuncture administration,it can reduce re-currence rate,with good safety.
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Objective To explore the correlation between radius and respiratory variation of inferior vena cava(IVC)and hemodynamic monitoring values of pulse-indicated continuous cardiac output(PiCCO)in septic shock pigs.Methods A total of 8 pigs were used to establish animal model of septic shock by intravenous infusing LPS(100 μg/kg),and fluid resuscitation was followed with normal saline.Ultrasound was used to measure the maximum radius(IVCmax)and minimum radius(IVCmin)of IVC,and respiration variation index(RVI)was calculated at basic status,septic shock,1 hour and 6 hours after fluid resuscitation,respectively.Respiratory variation index of IVC were calculated as:RVI =(IVCmax-IVCmin)/ IVCmax × 100％.Hemodynamic monitoring values,including ITBV,GEDV,SVV and CI of PiCCO,were recorded at the same time.Radius and RVI of IVC and PiCCO values between before and after fluid resuscitation were compared by LSD-t test.Correlation between radius and RVI of IVC andhemodynamic monitoring values were calculated by Pearson correlation coefficient.Results Compared with the moment of septic shock,IVC IVCmin,GEDV,ITBV and CI at 1 after hour fluid resuscitation were larger(P ＜ 0.01)and SVV and IVCrvi were smaller(P ＜ 0.01).Compared with the moment of septic shock and 1 after hour fluid resuscitation,IVC[VCmin,GEDV,[TBV and CI at 6 hours after fluid resuscitation were larger(P ＜ 0.01)and SVV and IVCrvi were smaller(P ＜ 0.01).IVCmax correlated with SVV(P=0.024)and it failed to correlate with GEDV,ITBV and CI.IVCmin correlated with GEDV(P=0.003),ITBV(P =0.001),SVV(P =0.009)and CI(P =0.015),respectively.RVI was correlated withGEDV(P＜0.01),ITBV(P＜0.01),SVV(P=0.007)and CI(P＜0.001),respectively.Conclusions Radius and RVI of IVC was correlated with hemodynamic monitoring values of PiCCO.It can serve as a parameter to rapidly estimate the blood volume.
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Objective To explore the correlation of the radius and respiratory variation of inferior vena cava(IVC)with central venous pressure(CVP)for rapid evaluation of blood volume with ultrasound in elderly patients with septic shock.Methods The radius of IVC was measured using bedside ultrasound,respiration variation index(RVI)was calculated as following:RVI =(maximum radius-minimum radius)/maximum radius × 100％ and central venous pressure(CVP)was also recorded in 28 elderly patients with septic shock before and during 2 h and 6 h fluid recovery.Radius and RVI of IVC were compared between 28 shock patients and 22 healthy volunteers as control.Correlation of radius and RVI of IVC with CVP were analyzed.The thresholds of radius and RVI of IVC to estimate CVP 8 mmHg were determined by Receiver Operator Characteristic Curve (ROC)curves.Results The maximum and minimum radius[(1.23±0.28)cm and(0.48±0.18)cm]in the elderly patients with septic shock were smaller than in control group[(1.95±0.14)cm and (1.73±0.13)cm].RVI in the elderly patients with septic shock were larger than in control group [(55.88±11.18)％ vs.(11.23± 1.82)％].The maximum and minimum radius were positively(r=0.668 and 0.863,both P＜0.01)and RVI negatively(r=-0.848,P＜0.01)with CVP.The thresholds of maximum radius,minimum radius and RVI of IVC to estimate CVP 8 mmHg were 1.56cm(sensitivity 85.2％,specificity 86.3％),1.13 cm(sensitivity 96.3％,specificity 94.1％)and 30％(sensitivity 88.2％,specificity 96.3％),respectively.Conclusions Using ultrasound to measure radius of IVC and calculate RVI might estimate CVP to certain degree.It might be an option for physicians to rapidly estimate blood volume in the elderly patients with septic shock.
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Objective To explore the impact of ischemic stroke on intestinal barrier changes in dogs.Methods Totally 20 mongrel dogs were divided into 2 groups by random number table with 10 in each.Double silicone cylinders measuring 1.1 mm in diameter and 8 mm in length were placed into their internal carotid arteries in all dogs of group A.Group B served as a control group and received sham operation.Light microscopy was performed for morphological measurement of intestinal epithelial cell.Immunohistochemistry was used to analysis the changes of protein zonula occludens-1(ZO-1)localizing at tight junction of intestinal epithelial cells.Results Ischemic stroke was confirmed by cranial CT scanning in all dogs of group A.Compared with the test results in group B,the occludin and Zo-1 protein levels in group A were significantly lower than those in group B(occludin:0.20 ±0.01 vs 0.22 ±0.01,P =0.007; ZO-1:0.20 ±0.01 vs 0.22 ±0.02,P =0.008).The apoptotic index in group A was significantly higher than in group B(29.04 ± 3.79 vs 6.44 ± 1.24,P =0.002).There was a positive correlation between occludin and ZO-1(R =0.71,P =0.02),and the apoptotic index was negatively correlated with levels of occludin,ZO-1(R =-0.91,P =0.00; R =-0.77,P =0.01).Light microscopy showed that the dogs in group A had intestinal mucousal injuries while no obvious change was detected in group B.Conclusions Dogs with ischemic stroke tend to develop intestinal barrier dysfunction,during which the destruction of tight junction plays a key role.The up-regulated apoptosis of intestinal epithelial cell constitutes one of the cellular bases of intestine injury.