Análise temporal das notificações de leishmaniose visceral humana (LVH) da Microrregião de Pirapora-MG / Temporal analysis of notifications of human visceral leishmaniasis from the microregion of Pirapora ­ MG

Analisa o perfil epidemiológico da Leishmaniose Visceral Humana (LVH) nos municípios da microrregião de Pirapora. Métodos: Foram descritos e analisados, os dados epidemiológicos dos casos de LVH notificado na microrregião de Pirapora, no período de 2016 a 2020, avaliando tempo (número anual de casos por ano), (município) e dados das pessoas acometidas, tais como (sexo, idade, oportunidade de diagnóstico e de notificação do caso suspeito e caso final, estimativa de incidência e óbitos). Resultados: Foram notificados e confirmados 33 casos de LVH, distribuídos em seis municípios. Destes, 27 (81,82%) eram homens e 6 (18,18%) mulheres, a faixa etária mais prevalente foi de pessoas entre 40 - 59 anos, sendo os homens os mais acometidos. O maior número de registros positivos foi no ano de 2017 com uma incidência de 8 (15,15%) pessoas, caracterizando a região como área moderada de transmissão atingindo durante o período 2,7 casos/ano. Ocorreu 1 (3,03%) óbito durante todo o período, no ano de 2017 Conclusões: A microrregião de Pirapora caracteriza-se como área moderada para transmissão para Leishmaniose Visceral Humana. Medidas de prevenção e controle como o uso de inseticidas em massa, eliminação dos focos de reprodução do mosquito, uso de repelentes, telas nas janelas e programas de educação continuada nessas regiões devem ser incentivadas para evitar que novos indivíduos se infectem

To analyze the epidemiological profile of Human Visceral Leishmaniasis (LVH) in the municipalities of the micro-region of Pirapora. Methods: The epidemiological data of the cases of LVH notified in the micro-region of Pirapora, in the period from 2016 to 2020, were described and analyzed, evaluating time (annual number of cases per year), (municipality) and data of the affected people, such as (gender, age, timeliness of diagnosis and notification of the suspected and final case, estimated incidence and deaths). Results: 33 (100%) cases of LVH were notified and confirmed, distributed in six municipalities. Of these, 27 (81.82%) were men and 6 (18.185%) were women, the most prevalent age group was people between 40 - 59 years old, with men being the most affected. The highest number of positive records was in 2017 with an incidence of 8 (15.15%) people, characterizing the region as a moderate transmission area reaching 2.7 cases/year during the period. There was 1 (3.03%) death during the entire period, in 2017. Conclusions: The Pirapora microregion is characterized as a moderate area for transmission of Human Visceral Leishmaniasis. Prevention and control measures such as the mass use of insecticides, elimination of mosquito breeding sites, use of repellents, window screens and continuing education programs in these regions should be encouraged to prevent new individuals from becoming infected

Treating children's tic disorder based on " visceral theory" from lung, liver and spleen / 国际中医中药杂志

The pathogenesis of tic disorder in children is closely related to the dysfunction of the internal organs, especially the lung, spleen and liver. The main causes of tic disorder caused by visceral disorders are as follows: lung guard is the main cause of the disease, liver wind is the key to the pathogenesis and spleen deficiency and wind phlegm are the pathological basis. At the same time, the lung, liver, and spleen are mutually restrictive and affect each other. The main manifestations are that if the lung is affected by evil, the wood will punish the gold; if the spleen is insufficiency and the liver is hyperactive, the earth deficiency will be leading to over-restriction by wood. Based on the understanding of the related theories about viscera's disease and viscera's generation, we pay attention to distinguish the etiology and pathogenesis of the viscera, and we treat tic disorders based on syndrome differentiation of lung, liver and spleen with curative effect.

Clinical study of acupuncture using the principle of invigorating viscera and purging fu, replenishing qi and nourishing yin for the type 2 diabetes mellitus patients with qi and yin deficiency / 国际中医中药杂志

Objective:To evaluate the effect of acupuncture with invigorating viscera and purging fu, replenishing qi and nourishing yin for the T2DM patients with qi and yin deficiency syndrome.Methods:A total of 59 patients who met the inclusion criteria from January 1, 2019 to December 31, 2020 in the Endocrinology Department of the Second Affiliated Hospital of Anhui University of Chinese Medicine were divided into the acupuncture group with 30 cases and a control group with 29 cases, according to the random number table method. The control group received conventional hypoglycemic treatment. And the acupuncture group was treated with acupuncture on the basis of the control group treatment. Both groups were treated for 4 weeks. TCM syndrome scores were performed before and after treatment, respectively. Serum IL-6 was measured by ELISA, serum CRP by immunoturbidimetry, and serum fasting blood glucose (FPG), 2 hPG, HbAlc, TC, TG, HDL-C, LDL-C levels by spectrophotometry. The BMI, clinical effect rates were calculated.Results:The total effective rate was 96.7% (29/30) in acupuncture group and 75.9% (22/29) in control group, and the difference was statistically significant ( χ2=5.96, P<0.01). After treatment, the scores of fatigue, dryness of mouth and pharynx, spontaneous sweating and night sweating, shortness of breath and lazy speech in acupuncture group were significantly lower than those in the control group ( t values were 6.02, 4.31, 4.34, 3.63, respectively, all Ps<0.01). The serum CRP level in acupuncture group was significantly lower than that of the control group at 21, 48 d after treatment ( t values were -4.36, -3.75, respectively, all Ps<0.01), and IL-6 level was significantly lower than that of the control group at 14, 21, 28 d after treatment ( t values were -2.92, -5.35, -8.71, respectively, all Ps<0.01). After treatment, the serum TC [(4.62±0.68) mmol/L vs. (5.56±0.72) mmol/L, t=5.16], TG [(1.48±0.42) mmol/L vs. (2.12±0.89) mmol/L, t=3.55], LDL-C [(2.48±0.84) mmol/L vs.(3.02±0.95) mmol/L, t=2.32] in the acupuncture group were significantly lower than those in the control group ( P<0.05), HDL-C [(1.39±0.27) mmol/L vs. (1.26±0.22) mmol/L, t=-2.02] in the acupuncture group was significantly higher than that of the control group ( P<0.05). The serum FPG level at 21 d [(6.12±0.67) mmol/L vs. (6.57±0.61) mmol/L, t=-4.96], 28 d [(5.78±0.52) mmol/L vs. (6.49±0.58) mmol/L, t=-2.70] in acupuncture group were significantly lower than those in the control group ( P<0.01). The 2h PG level at 14 d after treatment [(10.23±1.06) mmol/L vs. (11.76±1.34) mmol/L, t=-4.87], 21 d [(9.05±0.98) mmol/L vs. (10.53±1.24) mmol/L, t=-5.10], 28 d [(7.45±0.69) mmol/L vs. (9.31±0.78) mmol/L, t=-9.71] in the acupuncture group were significantly lower than those in the control group ( P<0.01), and HbA1c level were decreased 14 d [(7.93±0.86)% vs. (8.52±0.97)%, t=-2.47], 21 d [(7.63±0.85)% vs. (8.15±0.92)%, t=-2.26], 28 d [(6.47±0.51)% vs. (7.51±0.62)%, t=-7.05] significantly lower than those in the control group ( P<0.01), BMI [(22.13±1.57) kg/m 2vs. (24.16±1.82) kg/m 2, t=-4.59] 28 d after treatment was significantly lower than that of the control group ( P<0.01). Conclusion:Acupuncture therapy of nourishing viscera and purging fu, nourishing qi and nourishing yin can regulate the disorder of glucose and lipid metabolism in patients with T2DM and syndrome of qi and yin deficiency.

Construction of Predictive Model in 9 037 Patients with Stroke / 中国实验方剂学杂志

ObjectiveTo develop and validate a predictive model to individually predict the risk of patients with stroke in the eICU Collaborative Research Database for early clinical identification and intervention. MethodIndividual patient data （200 859 cases） from a national multicenter cohort study （eICU database） were selected， and the patients with stroke in neurological diseases （9 037 cases） were selected for statistical analysis. The main outcome was hospital mortality. The Glasgow Coma scale （GCS） was used to divide all patients with stroke into stroke in meridian and stroke in viscera （GCS≤14 for stroke in viscera and GCS=15 for stroke in meridian）. The patients were then divided into a training set and a test set according to 7∶3， respectively， to evaluate the differences in hospital mortality between the two groups. The multivariate logistic regression was used to analyze the related factors affecting the prognosis of the two groups， and a predictive model was established. Receiver operator characteristic （ROC） curves were used to assess the discrimination of the predictive model. ResultThe predictive model based on 9 037 patients with stroke was established. The predictors of the stroke in meridian （4 475 cases） included pulmonary infection， mechanical ventilation， acute physiology， and chronic health status scoring system Ⅳ （APACHE Ⅳ） score. The predictors of the stroke in viscera （4 562 cases） included anticoagulation therapy （AT）， mechanical ventilation， acute physiology， and APACHE Ⅳ score. According to the predictors， the predictive models of the stroke in meridian and the stroke in viscera were constructed， respectively. The areas under the curve （AUC） of ROC of the training set and the test set of the predictive models of the stroke in meridian were 0.845 ［95% confidence interval （CI） （0.811， 0.879）］ and 0.807 ［95% CI （0.751， 0.863）］， respectively. The areas under the ROC curve of the training set and test set of the predictive models of the stroke in viscera were 0.799 ［95% CI （0.781， 0.817）］ and 0.805 ［95% CI （0.778， 0.832）］， respectively. The AUC of the predictive model of the training set and the test set were both above 0.7. ConclusionThe model established in this study can conveniently， directly， and accurately predict the hospital mortality risk of patients with stroke. Physicians and other healthcare professionals can use this predictive approach to provide early care planning and clinical interventions for patients with stroke during their hospital stay.

Anafilaxia a alfa-gal: um relato de caso paraibano / Alpha-gal anaphylaxis: a case report from Paraíba, Brazil

O presente relato apresenta um caso de anafilaxia tardia ao carboidrato alfa-gal em um adolescente da cidade de Belém, na Paraíba, Brasil. O paciente desenvolveu reação tardia à ingesta de carne e vísceras de animais. Ele mora em fazenda e tem contato próximo com animais potencialmente contaminados por carrapatos. Essa causa de reação alérgica é nova, e estudos começaram a atribuí-la a casos antes ditos idiopáticos. A anafilaxia é uma reação potencialmente fatal, que deve ser prontamente diagnosticada e tratada. Sendo assim, a descoberta de seu fator desencadeante é um dos principais itens que direcionam o tratamento. No Brasil, nenhum caso de anafilaxia por alfa-gal foi antes descrito na literatura local.

This report presents a case of late anaphylaxis to alpha-gal carbohydrate in a teenager living in the city of Belém, Paraíba, Brazil. The patient developed a late reaction to eating meat and offal of animals; he lives on a farm and has close contact with animals potentially contaminated by ticks. This cause of allergic reaction is new, and studies have started to attribute it to cases previously said to be idiopathic. Anaphylaxis is a potentially fatal reaction that must be promptly diagnosed and treated. Thus, the discovery of its triggering factor is one of the main items that guide treatment. In Brazil, no case of alpha-gal anaphylaxis had been described in the local literature.

Mobilização visceral em adultos com dor lombar inespecífica / Visceral mobilization in adults with unspecified lumbar pain

Objetivo: analisar a efetividade da mobilização visceral na melhora dos sintomas de dor lombar inespecífica. Método: participaram do estudo indivíduos de ambos os sexos, que apresentavam sintomas dor lombar. A qualidade de vida foi avaliada pela versão brasileira do Questionário de Qualidade de Vida - SF 36 e a intensidade da dor por uma escala visual analógica. Para todos participantes foi utilizado um protocolo de técnicas de mobilização visceral. Quanto à análise estatística, as variáveis foram avaliadas por meio do teste não paramétrico de Wilcoxon e os valores de significância equivalentes a 5%. Resultados: participaram do estudo sete indivíduos, sendo quatro participantes com idade entre 40 a 50 anos (58%) e três entre 51 a 60 anos (42%) anos, sendo um do sexo masculino e seis do sexo feminino. Em ambos os aspectos avaliados, intensidade da dor e qualidade de vida, indicam diferenças entre as distribuições dos dados antes e após o tratamento pelas técnicas de mobilização visceral. Do mesmo modo, algumas variáveis estão dentro do nível de significância estabelecido, indicando que houve diferença entre as distribuições dos dados antes e após a aplicação do tratamento. Conclusão: constatou-se melhora significativa em relação aos sintomas de lombalgia na amostra estudada, na incapacidade específica e intensidade da dor, aspectos físicos, dor e estado geral de saúde. (AU)

Objective: to analyze the effectiveness of visceral mobilization in improving the symptoms of nonspecific low back pain. Method: individuals of both sexes, who had low back pain symptoms, participated in the study. Quality of life was assessed using the Brazilian version of the Quality of Life Questionnaire - SF 36 and pain intensity using a visual analog scale. For all participants, a protocol of visceral mobilization techniques was used. As for the statistical analysis, the variables were evaluated using the Wilcoxon non-parametric test and the significance values equivalent to 5%. Results: seven individuals participated in the study, four participants aged between 40 and 50 years old (58%) and three between 51 and 60 years old (42%) years old, one male and six female. In both aspects evaluated, pain intensity and quality of life, indicate differences between data distributions before and after treatment by visceral mobilization techniques. Likewise, some variables are within the level of significance established, indicating that there was a difference between the data distributions before and after the treatment application. Conclusion: there was a significant improvement in relation to low back pain symptoms in the sample studied, in specific disability and pain intensity, physical aspects, pain and general health status.(AU)

Damage control in abdominal vascular trauma

In patients with abdominal trauma who require laparotomy, up to a quarter or a third will have a vascular injury. The venous structures mainly injured are the vena cava (29%) and the iliac veins (20%), and arterial vessels are the iliac arteries (16%) and the aorta (14%). The initial approach is performed following the ATLS principles. This manuscript aims to present the surgical approach to abdominal vascular trauma following damage control principles. The priority in a trauma laparotomy is bleeding control. Hemorrhages of intraperitoneal origin are controlled by applying pressure, clamping, packing, and retroperitoneal with selective pressure. After the temporary bleeding control is achieved, the compromised vascular structure must be identified, according to the location of the hematomas. The management of all lesions should be oriented towards the expeditious conclusion of the laparotomy, focusing efforts on the bleeding control and contamination, with a postponement of the definitive management. Their management of vascular injuries includes ligation, transient bypass, and packing of selected low-pressure vessels and bleeding surfaces. Subsequently, the unconventional closure of the abdominal cavity should be performed, preferably with negative pressure systems, to reoperate once the hemodynamic alterations and coagulopathy have been corrected to carry out the definitive management.

En pacientes con trauma de abdomen que requieren laparotomía, hasta una cuarta o tercera parte, habrán sufrido una lesión vascular. Las estructuras venosas principalmente lesionadas son la vena cava y las iliacas, y de vasos arteriales, son las iliacas y la aorta. El abordaje de este tipo de heridas vasculares se puede ser difícil en el contexto de un paciente hemodinámicamente inestable ya que requiera medidas rápidas que permita controlar la exanguinación del paciente. El objetivo de este manuscrito es presentar el abordaje del trauma vascular abdominal de acuerdo con la filosofía de cirugía de control de daños. La primera prioridad en una laparotomía por trauma es el control de la hemorragia. Las hemorragias de origen intraperitoneal se controlan con compresión, pinzamiento o empaquetamiento, y las retroperitoneales con compresión selectiva. Posterior al control transitorio de la hemorragia, se debe identificar la estructura vascular comprometida, de acuerdo con la localización de los hematomas. El manejo de las lesiones debe orientarse a la finalización expedita de la laparotomía, enfocado en el control de la hemorragia y contaminación, con aplazamiento del manejo definitivo. Lo pertinente al tratamiento de las lesiones vasculares incluyen la ligadura, derivación transitoria y el empaquetamiento de vasos seleccionados de baja presión y de superficies sangrantes. Posteriormente se debe realizar el cierre no convencional de la cavidad abdominal, preferiblemente con sistemas de presión negativa, para consecutivamente reoperar una vez corregidas las alteraciones hemodinámicas y la coagulopatía para realizar el manejo definitivo.

Maniobras de movilización visceral en el trauma vascular abdominal / Visceral mobilization maneuvers in abdominal vascular trauma

RESUMEN Fundamento: el trauma vascular abdominal constituye un reto para el cirujano. El control vascular es una condición sine qua non en los pacientes que reciben intervención quirúrgica frente a esta letal enfermedad, donde las maniobras de movilización visceral constituyen una herramienta clave en el tratamiento. Objetivo: explicar las maniobras de movilización visceral que pueden auxiliar al cirujano frente a un trauma vascular abdominal. Métodos: se realizó una búsqueda en las bases de datos Scopus, Medline, Cochrane, Hinari y Redalyc se utilizaron los descriptores: trauma vascular, abdomen, maniobras, movilización visceral. Resultados: se abordaron las maniobras de movilización visceral a tener en cuenta en el trauma vascular abdominal con una explicación de los principales pasos técnicos en cada una de ellas. Conclusiones: el conocimiento y aplicación de las maniobras de movilización visceral constituyen una herramienta útil en el tratamiento de pacientes con trauma vascular abdominal.

ABSTRACT Background: abdominal vascular trauma is a challenge for the surgeon. Vascular control is a sine qua non condition in patients who receive surgical intervention against this lethal pathology, where visceral mobilization maneuvers are a key tool in treatment. Objective: to explain the visceral mobilization maneuvers that can help the surgeon against abdominal vascular trauma. Methods: a search of the Scopus, Medline, Cochrane, Hinari and Redalyc databases was performed using the descriptors: vascular trauma, abdomen, maneuvers, visceral mobilization. Results: visceral mobilization maneuvers to be taken into account in abdominal vascular trauma were addressed with an explanation of the main technical steps in each of them. Conclusions: the knowledge and application of visceral mobilization maneuvers constitute a useful tool in the treatment of patients with abdominal vascular trauma.

Effect of increased visceral fat on the perioperative period of laparoscopic-assisted distal gastric cancer radical resection / 国际外科学杂志

Objective:To explore the effect of excessive visceral fat area (VFA) on the intraoperative risk and postoperative outcome of laparoscopic-assisted distal gastric cancer surgery (LADG).Methods:A retrospective selection of 82 patients who underwent LADG at the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from June 2017 to March 2018 was selected. The patients were divided into two groups according to the VFA value calculated by preoperative CT: high VFA group ( n=31) and the low VFA group ( n=51). Patients in the high-VFA group had VFA≥100 cm 2, and those in the low-VFA group had VFA<100 cm 2. The differences in operation time, blood loss, number of lymph node dissections, and postoperative complications (including intestinal obstruction, anastomotic fistula, pancreatic fistula, and abdominal infection) were statistically compared between the two groups. Measurement data were expressed as mean±standard deviation ( Mean± SD), comparison between groups was by t-test; comparison of count data between groups was by Chi-square test. The factors related to pancreatic fistula were tested by one-way variance test, and the factors with differences were entered into the multivariate Logistic regression analysis as independent variables. Results:In terms of surgical bleeding ( P=0.061), lymph node dissection ( P=0.089), postoperative anastomotic leakage ( P=0.210), intestinal obstruction ( P=0.275) and abdominal infection ( P=0.130), the comparison between the two groups showed no significant statistical difference ( P>0.05), but compared with the low VFA group, the operation time of the high VFA group was prolonged [(258±91)min vs (230±82)min, P=0.018], and the onset of pancreatic fistula rate was significantly higher (11/31 vs 3/51, P=0.001), and there was statistical significance between the two groups ( P<0.05). The results of univariate analysis showed that gender and VFA were risk factors for pancreatic fistula; the results of multivariate analysis showed that VFA was a predictor of pancreatic fistula. Conclusion:Excessive VFA prolongs LADG operation time and is more valuable in predicting the occurrence of postoperative pancreatic fistula.

Association between visceral adiposity index and nonalcoholic fatty liver among overweight and obese children in Beijing / 中国学校卫生

Objective@#To examine the association between the visceral adiposity index (VAI) and nonalcoholic fatty liver disease (NAFLD) in the pediatric population in order to improve risk stratification and prevention systems for chronic liver disease.@*Methods@#A total of 510 overweight/obese children aged 6-8 years old were enrolled from the child cohort which was designed to study puberty, obesity, and cardiovascular risk (PROC), and complete data from liver ultrasounds and the VAI were obtained. Used Spearman s rank correlation coefficient, Chi-square tests, and Logistic regression analyses to explore the association between the VAI and NAFLD.@*Results@#The detection rates of NAFLD for boys and girls were 25.9% and 11.1%, respectively. VAI for normal group and the NAFLD group were 0.43(0.31, 0.61) and 0.61(0.44, 0.87) in boys, and 0.74(0.56, 1.07) and 1.08(0.67, 1.51) in girls, respectively. Spearman s correlation coefficient analysis showed that triglycerides(TG), VAI, and the third quintile VAI group were positively correlated with NAFLD in both boys and girls(r=0.19,0.26,0.29;0.16,0.16,1.18,P<0.05), and high-density lipoprotein-cholesterol (HDL-C) was negatively correlated with NAFLD in boys (r=-0.21, P<0.05). With advancing tertiles of VAI, the increasing trend in the NAFLD detection rate was statistically significant in boys and girls(Chi-square for trend were 21.77,7.66, P<0.01). The results of univariate and multivariable Logistic regression showed that, by taking the first tertile of VAI as a reference, the risk of NAFLD among boys was higher in the second tertile (cOR=2.59, 95%CI=1.15-5.86; aOR=2.33, 95%CI=1.01-5.36) and in the third tertile(cOR=5.73, 95%CI=2.62-12.53; aOR=4.87, 95%CI=2.15-11.03), where as the risk among girls was higher in the third tertile(cOR=4.43, 95%CI=1.40-14.00).@*Conclusion@#VAI is positively correlated with pediatric NAFLD. Higher tertiles of VAI were associated with an increased risk of NAFLD in overweight and obese children, which indicates that VAI can be used as an early predictor of NAFLD.

Toxicity of Chemotherapeutics Based on Viscera-state doctrine / 中国实验方剂学杂志

Malignant tumors are important diseases that threaten human health. Although targeting and immunotherapy have been gradually applied in the treatment of malignant tumors in recent years， which can alleviate the suffering of patients to a certain extent， there are still problems of large adverse reactions and easy drug resistance. At present， chemotherapy is still the main method for the treatment of malignant tumors. While killing tumor cells， chemotherapy also damages normal cells， which often leads to drug toxicity， such as bone marrow suppression， gastrointestinal adverse reactions， liver and kidney function damage， and oral mucosal reactions. Although modern medicines have a certain effect on the toxicity of chemotherapy drugs， there are still limitations. Traditional Chinese medicine（TCM） has a long history of treating malignant tumors， and considers that chemotherapy is a drug with toxin invading the body， exacerbating the "deficiency"， "toxin" and "stasis" of the body， causing damage to Qi， blood and organs， especially in spleen， stomach， liver and kidney， and leading to bone marrow suppression， liver and kidney function injury and other adverse reactions. Studies have confirmed that the use of TCM treatment has a better clinical efficacy. Therefore， new therapies shall be explored based on the basic theory of traditional Chinese medicine. As the core part of the theoretical system of TCM， Viscera-state doctrine is closely related to looking， listening， questioning and feeling the pulse of TCM， and has constantly developed and improved. It has important significance in guiding diagnosis and treatment of diseases. This study is guided by viscera-state doctrine of TCM and based on the etiology and pathogenesis of TCM. It starts with the clinical manifestations of common drug toxicity of chemotherapy drugs， such as bone marrow suppression， gastrointestinal adverse reactions， liver and kidney function damage， oral mucosal reactions， which are external signs of the toxicity of chemotherapeutic drugs， and associates pathological manifestations of viscera to physiological functions. From elephants and Tibetans， it systematically summarizes the viscera characteristics of various common chemotherapeutic drugs and provides new ideas and methods for clinical use of TCM in treating the toxicity of chemotherapeutic drugs， so as to promote the application of viscera-state doctrine in diagnosis and treatment of diseases.

Clinical Efficacy of Modified Qingyitang Combined with Blood Purification on Severe Acute Pancreatitis Complicated with Multiple Organ Dysfunction Syndrome / 中国实验方剂学杂志

Objective::To explore the effect of modified Qingyitang combined with continuous blood purification in the adjuvant treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction (MODS) caused by heat accumulation of viscera. Method::Totally 100 cases of patients of SAP complicated with MODS, who were diagnosed as heat accumulation of viscera by traditional Chinese medicine(TCM) and treated in ICU of the First Affiliated Hospital of Hunan University of Chinese Medicine during May 2015 and May 2019, were randomly divided into two groups, namely control group and observation group, with 50 cases in each group. The patients in control group were treated with fasting and abstinence, gastrointestinal decompression, inhibition of trypsin secretion, gastric mucosal protection, early jejunal nutrition, reduction of inflammatory reaction, continuous blood purification (CBP), mechanical ventilation and circulatory support. The patients in observation group were treated by nasojejunal tube according to syndrome differentiation in addition to routine comprehensive therapy. Modified Qingyitang was injected for 7 days. The remission time of abdominal pain and distention, the time of first exhaust and defecation, the time of ICU residence, the number of samples falling off, the cause of death and the number of cases were recorded. Relevant indexes were measured before treatment, on the 3rd and 7th day of treatment, including the evaluation indexes of pancreatitis: blood amylase (AMS), blood lipase (LPS), and modified computed tomography severity index (MCTSI), inflammatory response indexes were interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP). Organ function indexes included APACHE-Ⅱ, arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), glutamyltransferase (γ-GGT), urine volume, creatinine (CREA), urea nitrogen (UREA), glomerular filtration rate (GFR), creatine kinase (CK), creatine kinase isoenzymes (CKMB), lactate dehydrogenase (LDH), myoglobin (Mb). Tissue perfusion evaluation indexes included acute physiology and chronic health score, serum lactic acid (Lac) and central venous pressure (CVP). TCM treatment score was based on the syndrome score of acute pancreatitis with heat accumulation of viscera syndrome. Result::The total effective rate of TCM syndromes was 86.67%(39/45) in observation group and 73.91%(34/46) in control group (χ2 =13.524, P<0.01). On the 7th day of treatment, the symptoms and indicators of the two groups were improved. Compared with before treatment, AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT and AST were improved on the 3rd and 7th day after treatment in observation group and control group. The levels of AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT, AST, ALP, γ-GGT, urine volume were significantly improved (P<0.05). Compared with control group on the 3rd and 7th day, the levels of AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT, AST, ALP, γ-GGT, urine volume were significantly improved (P<0.05). CREA, UREA, GFR, CK, CKMB, LDH and Mb were significantly improved (P<0.05). Compared with control group, the abdominal pain, abdominal distension relief time, first exhaust/defecation time, ICU stay time in observation group were significantly shortened (P<0.05), and the mortality rate in observation group was significantly reduced (P<0.05). Conclusion::Patients of SAP accompanied with MODS can be treated with blood purification combined with modified Qingyitang by promoting pancreas repair, inhibiting inflammation and improving organ function. It plays an important role in improving symptoms, alleviating TCM syndromes, delaying progression of disease, reducing hospital stay and reducing mortality.

Effects of different doses of dopamine on organ function of rats at early stage of severe scald / 中华烧伤杂志

Objective@#To explore the effects of different doses of dopamine on organ function of rats at early stage of severe scald.@*Methods@#Thirty-two male Wistar rats aged 8 to 12 weeks were divided into sham injury (SI) group, simple resuscitation (SR) group, small dose (SD) group, and moderate dose (MD) group according to the random number table, with 8 rats in each group. After rats in the 4 groups were performed cardiac catheterization, rats in group SI were sham injured on the back by immersing in 37 ℃ warm water for 18 s, and rats in the other 3 groups were inflicted with 30% total body surface area (TBSA) full-thickness scald on the back by immersing in 97 ℃ hot water for 18 s. Rats in group SI were not treated after the injury, while rats in the other 3 groups were performed fluid resuscitation for 24 h through jugular vein catheter with micro syringe pump according to the Parkland formula. They were given 4.0 mL·kg-1·% TBSA-1 normal saline during the first 24 h, of which they were given half of the total amount for the first 8 h, and they were given half of the total amount for the second and third 8 h. Rats in group SR were infused normal saline only, while rats in group SD and group MD were infused normal saline+ 1.25 μg·kg-1·min-1dopamine and normal saline+ 6.00 μg·kg-1·min-1 dopamine respectively. Volume of 0.5 mL venous blood of all rats were taken through the cardiac catheter with serum separated at post injury hour (PIH) 1, 3, 6, 12, and 24. Serum content of cardiac troponin I (cTnI) was determined by enzyme-linked immunosorbent assay; serum content of diamine oxidase (DAO) was detected by ultraviolet spectrophotometer; serum content of β2-microglobulin (β2-MG) was determined by latex-enhanced immunoturbidimetric assay; serum content of total bile acid (TBA) was determined by enzyme colorimetry; serum content of lactic acid, malondialdehyde, and myeloperoxidase (MPO) was determined by ultraviolet spectrophotometer. Data were processed with analysis of variance for repeated measurement, one-way analysis of variance, least significant difference test, and Bonferroni correction.@*Results@#(1) At PIH 1, 3, 6, 12, and 24, serum content of cTnI of rats in group SR, group SD, and group MD [(2.69±0.19), (3.04±0.19), (4.96±0.25), (6.88±0.28), (4.75±0.31) μg/L, (2.70±0.14), (3.08±0.13), (5.06±0.19), (7.11±0.21), (4.89±0.16) μg/L, (2.18±0.14), (2.54±0.09), (3.97±0.14), (5.46±0.34), (3.32±0.33) μg/L] were higher than that in group SI [(1.70±0.08), (1.70±0.08), (1.69±0.11), (1.69±0.08), (1.70±0.08) μg/L, P<0.05], serum content of cTnI of rats in group SR and group SD was similar (P>0.05), and serum content of cTnI of rats in group MD was lower than that in group SR and group SD (P<0.05). (2) At PIH 1 to 24, serum content of DAO of rats in group SR, group SD, and group MD was higher than that in group SI (P<0.05), serum content of DAO of rats in group SR and group MD was similar (P>0.05), and serum content of DAO of rats in group SD was lower than that in group SR and group MD (P<0.05). (3) At PIH 1 to 24, serum content of β2-MG of rats in group SR, group SD, and group MD was higher than that in group SI (P<0.05), serum content of β2-MG of rats in group SR and group MD was similar (P>0.05), and serum content of β2-MG of rats in group SD was lower than that in group SR and group MD (P<0.05). (4) At PIH 1 to 24, serum content of TBA of rats in group SR, group SD, and group MD was similar (P>0.05) and higher than that in group SI (P<0.05). (5) At PIH 1 to 24, serum content of lactic acid of rats in group SR, group SD, and group MD was higher than that in group SI (P<0.05), serum content of lactic acid of rats in group SR and group MD was similar (P>0.05), and serum content of lactic acid of rats in group SD was lower than that in group SR and group MD (P<0.05). (6) At PIH 1 to 24, serum content of malondialdehyde and MPO of rats in group SR, group SD, and group MD was higher than that in group SI (P<0.05), serum content of malondialdehyde and MPO of rats in group SR and group MD was similar (P>0.05), and serum content of malondialdehyde and MPO of rats in group SD was significantly lower than that in group SR and group MD (P<0.05).@*Conclusions@#With effective liquid recovery, dopamine of MD can improve early cardiac function of rats with severe scald, while dopamine of SD can alleviate tissue ischemia and hypoxia, reduce oxygen free radical damage in internal organs, and improve functions of intestine and kidney.

Clinical study on self-made Jianpi-Tiaogan-Wenshen decoction in the treatment of diarrhea-predominant irritable bowel syndrome / 国际中医中药杂志

Objective@#To evaluate the efficacy of self-made Jianpi-Tiaogan-Wenshen decoction in the treatment of diarrhea-predominant irritable bowel syndrome (IBS).@*Methods@#A total of 107 patients with diarrhea- predominant IBS who met the inclusion criteria were divided into control group (53 cases) and observation group (54 cases) by random number table method. On the basis of routine treatment, the control group was given Bifidobacterium triple viable powder and trimebutine maleate dispersible tablets, while the observation group was given self-made Jianpi-Tiaogan-Wenshen decoction. Both groups were treated for 4 weeks. The symptoms and signs were scored before and after treatment. The level of 5-hydroxytryptamine (5-HT) was measured by double antibody sandwich method. The mast cell count was observed under high power microscopy, and the clinical efficacy was evaluated.@*Results@#The total effective rate was 90.7% (49/54) in the observation group and 60.4% (32/53)in the control group, and there was significant difference between the two groups (χ2=13.406, P<0.01). After treatment, the levels of mast cell count (10.03 ± 2.19 pcs/Hp vs. 14.85 ± 1.98 pcs/Hp, t=11.935), 5-HT (7.06 ±1.37 mg/L vs. 9.67 ± 1.31 mg/L, t=10.069) significantly decreased in the observation group (P<0.05). After treatment, the VAS score, stool frequency score and stool character score of the observation group were significantly lower than those of the control group (t=11.560, 11.957, 20.539, respectively, P<0.05).@*Conclusions@#Self-made Jianpi-Tiaogan-Wenshen decoction can improve clinical symptomsof diarrhea-predominant IBS patients, reduce mast cell count and 5-HT level, and improve the clinical efficacy.

Current Researches and Ideas Regarding Correlation Between Meridians and Viscera / 针刺研究

The correlation between meridians and viscera is the key content of the meridian theory in acupuncture medicine. This paper introduces the close relationship between the meridians running on the body surface and viscera from ancient lite-rature, modern experimental studies (such as acupoint sensitization, neuro-endocrine-immune networks, etc.), and clinical application in the treatment of various conditions with acupuncture, moxibustion, Guasha (scraping) therapies, etc. We also presented some related research ideas (i.e., taking the clinical treatment as the forerunner, paying more attention to multi-disciplinary integration, combining clinical and basic research together, doing research from tridimensional point of review, and making full use of advanced technology, etc.) in order to provide a possibly favorable help for researchers to further reveal the scientific mechanisms underlying correlation between the meridian and viscera in the future.

Analysis on Correlation Between Meridians and Viscera in Book The Yellow Emperor's Internal Classic / 针刺研究

The meridians and Zangfu-organs (viscera) are two major systems in the basic theory of traditional Chinese medicine (TCM). They were primarily emerged together in simple form possibly in the Han Dynasty shown by the unearthed silk manuscripts of Changsha Mawangdui Han Tomb, and became a systematic theory in classical book "Neijing" (The Yellow Emperor's Internal Classic). After classification of the meridians' disease manifestations described in book "Ling Shu-Jing Mai" (Miraculous Pivot: Meridians) we found that more than half of the manifestations appear along the running course of meridians. The symptoms and signs of disorders of the meridians correlated with viscera which have the same name in western medicine account for approximately 10%, and the rest pathologic manifestations correlated with the viscera in terms of TCM are approximately 30%. Current researches about meridian and viscera mainly focus on viscera, particularly on the stomach and heart. The researches on meridians and viscera that use real-time effects of acupuncture as indicators have a complicated relationship with the nerve segments, which presented as that "multiple meridians control one viscus" and the specificity of meridian. Our chronic experiment about blocking the meridians suggested an association between meridian and pathologic manifestations of viscera. Physical index measurement and mathematical analysis can verify certain patterns of meridian-physical appearances, which would be a direction for future meridian research. The stabilities of visceral functions rely on negative feedback regulation, which are probably realized by way of somatic and visceral afferent and efferent nerves and volume transmission of the tissue fluid channels of meridians. Therefore, signals of acupuncture stimulation of the distant acupoints might be transmitted to the central nervous system through neurohumor relay, open of the "negative feedback channels of meridians", achieving a bidirectional regulation, and at the same time, producing a phenomenon of "sensation propagated along the meridian" during signal transmission.

Unraveling Mysteries of Correlation Between Meridians and Viscera in Connection Between Upper and Lower, Interior and Exterior of the Human Body / 针刺研究

The theory that meridians connect the upper and lower, interior and exterior of the whole human body comes from the clinical experience of acupuncture therapy mainly by choosing the acupoints of 12 regular meridians at the four limbs. During the process of merging the theories of meridians and Zangfu-organs (viscera), the expression of the intrinsic relationship of such connection gradually becomes more and more complicated. Therefore, the study on the correlation between the meridian and viscus should start from the characteristics of the meridian theory itself, and discriminate the "reasonable and unreasonable" components of the related theoretical descriptions in the literature in order to explore the scientific values of this correlation. Based on this viewpoint, the present article makes a brief analysis on this proposition from the following two angles of view: the understan-ding of such proposition and the historical evolution of the meridian theory.

Analysis of Five Visceral in Polycystic Ovary Syndrome / 浙江中医药大学学报

[Objective]To explore the pathological mechanism and treatment of polycystic ovary syndrome in traditional Chinese from the angle of five viscera, and to enrich the theory in differentiation syndrome of solid-hollow viscera.[Methods]Based on ancient literature and modern clinic investigation,we discuss polycystic ovary syndrome from five viscera,at the same time,different viscera has its own etiology and pathogenesis,so according to five viscera syndrome differentiation,we can take different treatment and prescription respectively. [Results]The generation,transmission,mutual interaction of qi,blood,essence, body fluids in five viscera are dynamic.The pathological mechanism of polycystic ovary syndrome is based on the imbalance of qi,blood,essence,body fluids in internal organs,while phlegm wet and blood stasis are considered as treetop.Consequently,which are seen as the radical treatment such as to tonify and diffuse the lung, replenish qi and to calm down the heart, invigorate the spleen and nourish blood, to clear and soothe the liver, to tonify the kidney and secure the essence. While dampness drying, phlegm resolving, and blood activation are the treatment of treetop aspect, then they can reach the purpose of simultaneous treatment of treetop and root.As a result,the physiological function of five viscera will recover,clinical symptoms such as menstrual disorder, infertility,hirsutism and acne will be improved.[Conclusion]In clinic,we should start from the overall,broaden the train of thought,develop and innovate the application in differentiation syndrome of solid-hollow viscera.

Role of microglia in paraventricular nucleus in susceptibility to depression in rats with chronic vis-ceral pain / 中华麻醉学杂志

Objective To evaluate the role of microglia in paraventricular nucleus (PVN) in sus-ceptibility to depression in rats with chronic visceral pain. Methods Ninety-six pathogen-free healthy male Sprague-Dawley rats, aged 8 days, were divided into 6 groups (n= 16 each) using a random number table: sham operation group (S group), chronic visceral pain group (CHVP group), sham operation plus colorectal distension group (S+C group), chronic visceral pain plus colorectal distension group (CHVP+C group), chronic visceral pain plus phosphate buffer solution plus colorectal distension group (CHVP+P+C group) and chronic visceral pain plus minocycline plus colorectal distension group (CHVP+M+C group). Colorectal distension was not performed in S group. In CHVP group, chronic visceral pain was induced by performing colorectal distension twice daily on postnatal days 8, 10, and 12. Phosphate buffer solution 0. 5μl was injected into PVN by stereotaxic method at 8th week after birth in CHVP+P+C group, and 2％ mi-nocycline 0. 5 μl was injected into PVN at 8th week after birth in CHVP+M+C group. Eight rats in each group were selected 2 h later for measurement of visceral pain threshold. In S+C, CHVP+C, CHVP+P+C and CHVP+M+C groups, colorectal distension was performed for 2 times, open field test and sucrose preference test were then performed, the rats were sacrificed and PVN was removed for determination of micro-glial activation by immunofluorescence. Results The pain threshold was significantly decreased in CHVP, CHVP+C, CHVP+P+C and CHVP+M+C groups as compared with S and S+C groups (P<0. 05). The pain threshold was significantly increased in CHVP+M+C group when compared with CHVP +P +C group (P<0. 05). Compared with S, CHVP and S+C groups, the total locomotor distance, the number of rea-ring and sucrose consumption were significantly reduced, and the proportion of activated microglia in PVN was increased in CHVP+C, CHVP+P+C and CHVP+M+C groups (P<0. 05). Compared with CHVP+P+C group, the total locomotor distance, the number of rearing and sucrose consumption were significantly in-creased, and the proportion of activated microglia in PVN was decreased in CHVP+M+C group (P<0. 05). Conclusion Microglia in PVN is involved in regulation of susceptibility to depression in rats with chronic visceral pain.