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Threatened abortion is a common disease of obstetrics and gynecology and one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in TCM obstetrics and gynecology， Western medicine obstetrics and gynecology， and pharmacology to deeply discuss the advantages of TCM and integrated Chinese and Western medicine treatment as well as the medication plans for threatened abortion. After discussion， the experts concluded that chromosome， endocrine， and immune abnormalities were the key factors for the occurrence of threatened abortion， and the Qi and blood disorders in thoroughfare and conception vessels were the core pathogenesis. In the treatment of threatened abortion， TCM has advantages in preventing miscarriages， alleviating clinical symptoms and TCM syndromes， relieving anxiety， regulating reproductive endocrine and immune abnormalities， personalized and diversified treatment， enhancing efficiency and reducing toxicity， and preventing the disease before occurrence. The difficulty in diagnosis and treatment of threatened abortion with traditional Chinese and Western medicine lies in identifying the predictors of abortion caused by maternal factors and the treatment of thrombophilia. Recurrent abortion is the breakthrough point of treatment with integrated traditional Chinese and Western medicine. It is urgent to carry out high-quality evidence-based medicine research in the future to improve the modern diagnosis and treatment of threatened abortion with TCM.
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Objective:To explore the switch time of noninvasive-invasive mechanical ventilation sequential treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and effectively reduce the rate of tracheal intubation.Methods:A retrospective study was performed on patients with AECOPD, who underwent mechanical ventilation in emergency resuscitation room and admitted to department of respiration of Kaifeng Central Hospital Emergency Center from July 2014 to March 2019. The patients who used noninvasive mechanical ventilation (NIV) were included in NIV group (118 cases), and those who used invasive positive pressure ventilation (IPPV) were included in IPPV group (52 cases). The usage of breathing machine time, hospital days and hospital mortality were compared between the two groups. Clinical indicators such as age, gender, body temperature, respiratory rate, body mass index (BMI), mean arterial pressure (MAP), oxygenation index (PaO 2/FiO 2), respiratory index (RI), pH value, D-dimer, hemoglobin (HB), albumin, blood lactate (Lac), brain natriuretic peptide (BNP), C-reactive protein (CRP), procalcitonin (PCT), serum creatinine (SCr), white blood cell count (WBC), Glasgow coma scale (GCS), sputum excretion drainage were collected. The factors influencing the failure of NIV were analyzed by Logistic stepwise regression analysis. The receiver operating characteristic (ROC) curve was used to test the value of the NIV failure risk prediction model. Results:There was no significant difference in total mechanical ventilation time and hospital mortality between NIV group and IPPV group (hours: 65.6±11.11 vs. 66.9±12.1, 6.8% vs. 9.6%, both P > 0.05), but the hospital time in group NIV was significantly shorter than that in IPPV group (days: 12.3±2.1 vs. 14.2±2.5, P < 0.05). In NIV group, 101 cases completed NIV continuously, 17 cases of NIV failure turned to IPPV, and the failure rate of NIV was 14.4%. There were statistically significant differences in gender, PaO 2/FiO 2, RI, pH value, D-dimer, PCT, WBC, Lac, sputum excretion drainage and GCS score between NIV failure patients and NIV success patients. Logistic regression analysis showed that RI, pH value, WBC and sputum excretion drainage were independent risk factors for NIV failure [RI: odds ratio ( OR) = 3.879, 95% confidence interval (95% CI) was 1.258-11.963, P = 0.018; pH value: OR = 3.316, 95% CI was 1.270-8.660, P = 0.014; WBC: OR = 3.684, 95% CI was 1.172-11.581, P = 0.026; sputum excretion drainage: OR = 0.125, 95% CI was 0.042-0.366, P = 0.000]. The NIV failure risk prediction model based on the above independent risk factors had a good goodness of fit ( χ2 = 9.02, P = 0.34). ROC curve analysis showed that the NIV failure risk prediction model had a high predictive value for the patients with AECOPD [the area under ROC curve (AUC) was 0.818±0.051, 95% CI was 0.718-0.918, P = 0.000]. Conclusions:If patients with AECOPD have relative contraindications of NIV but still insist on using NIV, further risk stratification of NIV failure is needed. For those with RI, pH value, WBC abnormalities and sputum excretion drainage, the risk of choosing NIV is significantly increased. We need to pay more attention to the change of the condition and switch to IPPV in time to avoid exacerbation of the condition.
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Objective To analyze the risk factors of failure of emergency treatment with invasive mechanical ventilation (IPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The clinical data of 122 patients with AECOPD to undergo IPPV admitted to the Emergency Center of Kaifeng Central Hospital from July 2015 to March 2018 were retrospectively analyzed. The patient's general information [gender, age, body mass index (BMI)] and the patient's body temperature (T) at initial IPPV, respiratory rate (RR), mean arterial pressure (MAP), heart rate (HR), white blood cell count (WBC), hemoglobin (Hb), electrolyte (K+, Na+ and Cl-), pH value, D-dimer, albumin, C-reactive protein (CRP), blood lactic acid (Lac), B-type brain natriuretic peptide (BNP), procalcitonin (PCT), serum creatinine (SCr), oxygenation index, respiratory index (RI), the occurrence of serious arrhythmia or not, Glasgow coma score (GCS) were statistically analyzed. The indicators with statistical significance in the univariate analysis were introduced into the multivariate Logistic regression analysis to screen out the risk factors affecting the failure of IPPV in the patients; receiver operating characteristic (ROC) curve was drawn to analyze the test effectiveness of the risk factors. Results There were totally 98 cases underwent emergency IPPV, failure in 17 cases and success in 81 cases. The levels of oxygenation index, pH value, WBC and GCS scores of the IPPV success group were significantly higher than those of the IPPV failure group [oxygenation index (mmHg, 1 mmHg =0.133 kPa): 304.10±115.35 vs. 285.93±184.64, pH value: 7.34±0.17 vs. 7.18±0.24, WBC (×109/L): 40.90±8.72 vs. 26.61±6.86, GCS score: 12.42±1.35 vs. 9.89±2.13, all P < 0.05]; the levels of RI, D-dimer, PCT, Lac and incidence of serious arrhythmia in the IPPV success group were significantly lower than those in the IPPV failure group [RI: 2.53±2.39 vs. 3.69±3.64, D-dimer (mg/L): 1.80±0.06 vs. 3.16±2.60, PCT (μg/L): 1.36±0.65 vs. 2.23±2.07, Lac (mmol/L): 3.98±0.63 vs. 7.06±3.44, incidence of serious arrhythmia: 23.46% (19/81) vs. 47.06% (8/17), all P < 0.05]. Logistic regression analysis showed that RI [odds ratio (OR) = 3.479, 95% confidence interval (95%CI)= 1.248-11.996], pH value (OR = 3.153, 95%CI = 1.256-8.656), WBC (OR = 3.364, 95%CI = 1.171-11.561), and the occurrence of severe arrhythmia (OR = 4.125, 95%CI = 0.042-0.342) were risk factors affecting the prognosis of AECOPD patients treated with IPPV (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of RI, pH value, WBC and occurrence of severe arrhthmia was 0.718 (P = 0.012), 0.832 (P = 0.008), 0.645 (P = 0.004), 0.617 (P = 0.003), and the sensitivity were 37.0%, 55.6%, 81.5%, 60.4%, the specificity were 19.1%, 26.8%, 60.3%, 83.0% respectively, that had certain value to predict the failure of using IPPV to treat patients with AECOPD. Conclusion Multiple factors may result in failure in emergency patients with AECOPD to apply invasive mechanical ventilator for treatment, that may lead to death, and RI, pH value, WBC, the occurrence of severe arrhythmia are the independent risk factors of failure in such patients using IPPV; emergency physicians should pay attention to AECOPD patients' risk factors at initial period of using IPPV in order to give early warning after assessment.
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Objective To analyze the risk factors for the failure of noninvasive mechanical ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to help the clinical risk assessment and decision making.Methods A retrospective case control study was conducted.The patients with AECOPD undergoing NIV admitted to Kaifeng Emergency Center from June 2011 to March 2016 were enrolled,and they were divided into two groups according to whether NIV was successful or not within 12 hours.The nutritional status,blood gas analysis,serum electrolytes,D-dimer,renal function,serum pre-albumin,as well as kinetic vital signs,Glasgow coma scale (GCS) score,expression of respiratory distress,and spontaneous expectoration were recorded.Logistic forward stepwise regression analysis was used to analyze the factors for failure of NIV.Results 122 patients.with the initial NIV were enrolled,with NIV failure in 41 patients within 12 hours,accounted for 33.6％.Compared with NIV success group,the percents of respiratory rate ≥ 25 breaths/min (75.6％ vs.17.3％),expectoration disorders (78.0％ vs.19.8％),circulatory disorders (61.0％ vs.18.5％),malnutrition (61.0％ vs.11.1％),decreased serum pre-albumin (58.5％ vs.17.3％),and GCS score ＜ 12 (75.6％ vs.28.4％) in NIV failure group were significantly increased (all P ＜ 0.05).But there were no significant differences in gender,age,body temperature,blood gas analysis,D-dimer,serum creatinine between two groups.It was shown by the results of binary logistic regression analysis that respiratory rate,expectoration disorders,circulatory disorders,malnutrition,serum pre-albumin,and GCS score were the factors of NIV failure [odds ratio (OR) values were 10.879,6.338,9.860,23.273,8.862,6.774,and P values were 0.011,0.038,0.024,0.003,0.015,0.041,respectively].It was shown by the results of logistic stepwise regression analysis that respiratory rate ≥ 25 breaths/min,expectoration disorders,circulatory disorders,malnutrition,decreased serum pre-albumin,and GCS score ＜ 12 were independent risk factors of NIV failure (OR values were 6.610,5.403,5.138,8.153,4.979,5.100,and P values were 0.007,0.013,0.023,0.007,0.027,0.023,respectively).Conclusions The multiple independent risk factors can induce NIV failure within 12 hours in emergency patients with AECOPD,i.e.increased respiratory rate,expectoration dysfunction,circulatory disorders,malnutrition,decreased serum pre-albumin,and decreased GCS score.Emergency physicians should pay attention to these early risk factors in AECOPD patients,which can be taken as correct judgment and guide.
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The National Excellent Course of Gynecology of Chinese Medicine is a main clinical subject of TCM,which puts emphasis on clinical application.The non-medical doctoral students are lack of the knowledge of traditional Chinese medicine and clinical experience,and the existing classroom teaching has the problem of the basic theory of traditional Chinese medicine being out of line with the clinical application,which has become the hindering factors of TCM gynecology teaching.By designing and perfecting the process of preparation before class-classroom teaching-discussion teaching-clinical probation-after class feedback,the related teaching teachers better improve the non medical doctoral students' ability to put the traditional Chinese medicine gynecology basic knowledge into clinical practice,which is well received by the students.
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CM gynecology is one of the main courses of traditional Chinese medicine. The cultivation of the doctor-patient communication skills is a very important among the eduction of graduate students. The paper was encouraged to summarize the condition and problems of doctor-patient communication, in order to standardize CM gynecology training and improve the quality of teaching practice.
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Objective To compare the difference of pregnancy outcomes between women who had a history of recurrent spontaneous abortion ( RSA) and women who were primigravida. Methods A case-control study was carried out. A total of 98 cases with a history of RSA and giving birth in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January of 2010 to September of 2014 served as the case group, while 98 primigravida giving birth at the same period in the same hospital were randomly selected as controls. The information collection form was designed following literature review before the research. All of the available data, including maternal demographic, reproductive information, medical history and present pregnancy outcomes, were collected from in-patient medical records. The number of valid information forms in case group was 91 and was 94 in control group after excluding the forms with incomplete data. The data was analyzed with SPSS 16.0 software. Results Univariate analysis results showed that maternal age, marital status, distribution of ABO blood groups, the history of infertility, clinical manifestation of threaten abortion, miscarriage treatment during pregnancy, medication of Zishen Yutai Pills for preventing miscarriage, time of delivery, adverse pregnancy outcome, and newborn sex were statistically significant different between the two groups ( P<0.05) . Logistic regression analysis results showed that there were significant differences in 5 factors between the two groups. Maternal age ( OR=1.466, 95%CI=1.267-1.698) , medication of Zishen Yutai Pills for preventing miscarriage ( OR=4.484, 95%CI=1.073-18.519) , and adverse pregnancy outcome ( OR=8.850, 95%CI=2.994-26.316) were the risk factors of RSA. Set blood type O as the classification reference, blood type A was a protective factor ( OR=0.259, 95%CI=0.088-0.765). And newborn sex was another protective factor of RSA ( OR=0.336, 95%CI=0.139-0.813). Conclusion Older women or women with blood type O are more likely to suffer from RSA than women with blood type A. Comparing with primigravida, women who had a history of RSA are more willing to accept medication of Zishen Yutai Pills for miscarriage, and women giving birth of a boy are more likely to have RSA and thereatened abortion, having high risk of adverse pregnancy outcomes particularly for the increase of gestational diabetes incidence.
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The case is the cornerstone of case teaching. The construction of case database can support case teaching and its orderly development. The clinical cases of gynecology of Chinese medicine were collected, sorted and processed in combination with the teaching syllabus and teaching objective. Operating platform was based on the Excelltable. The column was divided into overview, menstrual disorders, leukorrhoeal diseases, pregnancy disease, postpartum disease and miscellaneous diseases of gynecology with hierarchical set of 15 modules per column, including basic information, complaints, history, symptoms, physical examination, diagnosis, application purpose and context and so on. And the corresponding search term was also selected. Cases can be divided into introduction cases and improvement ones according to their easiness and difficulty , into typical cases and atypical ones according to their feature types. Case database content also needs to be constantly revised by teaching activities to make it more suitable for clinical teaching.
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Professor OUYANG Hui-qing's gradually formed her own teaching concept of traditional Chinese medicine through long-term teaching practice:the most important teaching aim is to cultivate talents of traditional Chinese medicine.Clinical practice together with classroom teaching can promote the growing knowledge of medical students.Clinical practices are necessary and should penetrate culture and academic tradition of traditional Chinese medicine.OUYANG Hui-qing's concepts on talents are:cultivating teaching faculties is the key to the development of the teaching team,the core of construction of the teaching and research section,and the basis of construction of the discipline.OUYANG Hui-qing's management concepts are:the dean of the teaching and research section is the practitioner of personnel training practice and the undertaker of teaching team development.
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LUO Yuan-kai's idea on running the school, the school orientation, education and management and also the concept medical subject development is the most important part of his educational ideas, and it is the real practice and development of his educational ideas on higher Chinese medical education, and it is the practical support on how he became the famous Chinese medical educator and made his greatest educational achievement.
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LUO Yuan-kai's caring about Chinese medicine, taking his responsibility on teaching Chinese medicine and of course, his great knowledge, all made him a good educator. He made great contribution to Chinese higher medical education. His idea of education is the valuable spiritual wealth of Chinese higher medical education and has also profound inspiration to the development and innovation of 21st century's Chinese medical education.
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Objective:To study the effect of invigorating the kidney and spleen complex prescription on deltamethrin intoxicated pregnant rats. Methods:Pregnant rats were divided into 5 groups. Except the blank group,other groups were orally fed 1/20LD50(6.93mg/kg)DM daily from day 1 to 15 when proved pregrancy. 4 Hours later,rats in model group were given physiological saline,other 3 groups were given high/ median /low dose of Zhuyun Formula. Half pregnant rats were killed on D15. The rest was kept until labour. The abortion rate,survival rate,delivery condition,the level of estradiol,progestogen were observed. Results:With respect to abortion rate,model group showed statistical signifi cance when compared with other groups. Model group also showed low progesterone level. With the treatment Zhuyun Ⅲ,it had desirable effect in decreasing abortion rate,and increasing the level of progesterone. The labour time of all groups was within the normal range. Conclusion:DM had toxicity on reproduction,it could lead to abortion which was related to endocrine function of pregnant rats. Zhuyun Ⅲ could regulate the above condition and relief DM toxicity.
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【Objective】To explore the correlation of antisperm immune infertility(AII) in females with chronic genital tract inflammation and to observe the therapeutic effect of Chinese medicine of Qingshi Huayu Mixture(QHM) and Yishen Huoxie Prescription Ⅰ(YHPⅠ) for AII.【Methods】Fifty-eight AII patients were screened from 200 infertility patients,and were randomized into three groups.Group A(N=18) was treated with YHPⅠ,group B(N=20) with QHM and group C(N=20) with western medicine.Three months constituted one treatment course.The incidence of positive antisperm antibody(AsAb+)combined with chronic genital tract inflammation,therapeutic effect,pregnancy rate,the content of serum AsAb,as well as the changes of lymphocyte subtypes,natural killer(NK) and interleukin 6(IL-6) were observed.The correlation of the above indexes with serum AsAb content was also analyzed.【Results】(1) The incidence of positive antisperm antibody(AsAb+)combined with chronic genital tract inflammation: There were 96(48%)with AsAb+ in 200 patients,and 62(64.58%) with AsAb+ in 122 combined with chronic genital tract inflammation;there were 34(35.42%)AsAb+ patients in 78 without inflammation,the difference of AsAb+ incidence was significant between the inflammation patients and the non-inflammation patients(P0.05).There were 2 in 5 cured patients of group A,2 in 7 of group B and 1 in 7 of group C being pregnancy.(3) Content of serum AsAb: serum AsAb content was decreased in the three groups after treatment,the difference being significant as compared with that before treatment(P0.05).(4) The changes of lymphocyte subtypes,NK and IL-6: CD8+ was increased,CD4+/CD8+ and NK were decreased in groups A and B,the differences being significant as compared with those before treatment and those in group C after treatment(P
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【Objective】To observe the effect of Zhuyun Prescription Ⅲ(ZPⅢ),which is composed of kidney-tonifying and spleen-strengthening herbal medicine,on T lymphocyte antigen recognition receptors(TCR?&T) in luteal insufficiency abortion rats with deficiency of kidney.【Methods】Forty SD rats were equally randomized into 5 groups: blank control group,model group,high-and low-dose ZPⅢ groups(in the doses of 7.08 and 3.54 g?kg-1?d-1,respectively) and allylestrenol tablets(1.5 mg?kg-1?d-1) group.Luteal insufficiency abortion rats model with deficiency of kidney was established by hydroxyurea(450 mg?kg-1)and mifepristone(3.75 mg?kg-1).The uterus weight,the amount of embryo and the abortion rate were observed,and the peripheral blood levels of TCR?&T and CD3+T lymphocytes were detected with flow cytometer.【Results】The uterus weight and the amount of embryo were decreased,and the abortion rate was increased in the model group(P
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Guided by Professor Luo Yuankai and influenced by his academic thought, the gynecology department of the first hospital affiliated to Guangzhou University of TCM has made great achievements in the research of regulating menstruation, promoting gestation and calming fetus in recent 30 years. It is believed that based on the principle of kidney controlling the reproduction, kidney-tonifying therapy should be the principal method for the treatment of menstrual disease, pregnant disease and infertility which are characterized as deficiency syndrome.
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Objective:To study the immunological responds to sperm antigens in the condition of chronic inflammation in female reproductive tract. The results would be useful for preventing antisperm immunity infertility.Methods:①Patients: 50 women in chronic cervicities and/or chronic pelvic peritonitis were observed, and 10 healthy women for normal control. ②The patients and the control group were tested serum ASAb, pathogens culture in cervical mucus, subsequent lymphocyte (including CD3, CD4,CD8 and CD4/CD8),and IL 2 level in the cervical mucus.Results:①The serum ASAb level in the patients was higher than the control group (P
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Objective To investigate the relationship of mental status,personality characterstics and TCM syndromes of spontaneous abortion(SA).Methods Symptom Checklist 90,Measure of Mental Health,Eysenck Personality Questionnaire and Diagnostic Questionnaire of TCM syndromes were adopted.Multifactorial analysis was fitted by non-conditional logistic regression model.Results In patients with SA,a positive correlation of somatization factors and kidney dificiency,spleen deficiency,blood heat and liver-qi stagnation.A positive correlation was also found between hostility factors and kidney deficiency,obsessive-compulsive factors and liver-qi stagnation.Patients with melancholic temperament tended to manifest as the syndromes of kidney deficiency,spleen deficiency and liver-qi stagnation,and choleric temperament tended to manifest as blood heat and liver-qi stagnation.Conclusion The syndromes of kidney deficiency,spleen deficiency,blood heat and liver-qi stagnation at least partially reflect the psychosomatic reaction or psychosomatic disorder induced by mental factors.TCM syndromes has a relationship with mental status and personality characteristics.The nature of their relationship needs to be studied further.
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Objective To establish chromatographic fingerprint of water and ethanol soluble component of Radix Dipsaci by using HPLC for identifying and evaluating its quality. Methods HPLC method was set up with Agilent HC-C18 column. The mobile phase was comprised of acetonitrile(A) and 0.05mol/L KH2PO4-H3PO4 buffer solution pH=3.0(B) in gradient elution mode. UV detection wavelength was at 220 nm,with a flow rate of 1.0 mL/min. Results Ten batches of Radix Dipsaci samples from different habitats and harvested in different times were analyzed. HPLC fingerprint of medicinal material of Radix Dipsaci was established preliminarily. Seventeen characteristic peaks were confirmed and the fingerprints of different samples were compared by similarity evaluation software. Conclusion This method shows high precision and good repeatability,so it can be used to assess the quality of Radix Dipsaci.
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Objective To establish the method of measuring quercetin content in semen cuscutae(SC) and to explore its in- vivo pharmacokinetics features.Methods The rapid and sensitive HPLC- UV method was adopted with carbamazepine acting as internal standard. After the extract of SC was given, serum samples of rats were collected and measured on C18 reverse- phase chromatographic column after liquid- liquid extract. Results The linear range of calibration curve were 0.05～ 9? g/mL (r=0.9998). The method showed good precision and recoveries for serum with 86.65～ 99.07% , and extracting recoveries 79.91～ 84.56% .The limit of detection(LOD) as 0.05? g/mL. Conclusion The pharmacokinetic process of quercetin in vivo manifestated an opening two- compartment model with t1/2(Ab)=0.13h, t1/2(? )=0.19h, t1/2(? ) =1.22h, tmax=0.333h. The results may provide evidence of safety and effectiveness for clinical use of SC.
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Objective:To study the clinic effects of Prescription Zhuyun-Ⅲ(ZYⅢ) on early pregnancy women diagnosed as threatened abortion,and its mechanism in immunity and endocrine by determining the changes of serum Th1 and Th2-type cytokines,progesterone(P) and ?-human chorionic gonadotropin(?-HCG).Methods:The treatment group comprised of 30 early pregnancy women diagnosed as threateded abortion as well as deficiency syndrome of deficiency syndrome of Spleen or Kidney diagnosed by TCM,the control group consisted of 20 normal early pregnancy women at similar gestational age.The treatment group was administered with ZYⅢ for 4 weeks.Peripheral blood samples from the above two groups pre-and post-treatment were collected,serum Th1 type cytokine IL-2 and Th2 type cytokine IL-10 were determined by flow-cytometry.Serum P and ?-HCG were determined by ELISA.Results:①The serum IL-2 level and the ratio of IL-2/IL-10 in the treatment group before therapy were significantly higher than the control group(P