A case analysis of brucella infection in a non-epidemic area / 中华劳动卫生职业病杂志

The incidence of human brucellosis is on the rise worldwide. The disease can affect various systems. The clinical manifestations are complex and non-specific, and the diagnosis is difficult. Especially the clinicians in the non-epidemic areas have sporadic cases on the pest free areas. Lack of experience in diagnosis and treatment leads to misdiagnosis and mistreatment, which affects prognosis. This article reports on the epidemiology, clinical manifestations, laboratory tests and treatment of a patient with unexplained fever and brucellosis in our department in June 2019. Raise the attention of clinicians in non-epidemic areas to the disease and enhance people's awareness of protection in non-epidemic areas.

Expert consensus on diagnosis and treatment of septic shock with integrated traditional Chinese and Western medicine / 中华危重病急救医学

Septic shock is a pathological stage during the progress of sepsis. The mortality rate is high, and timely, standardized and comprehensive treatment is of great significance in reducing the mortality rate. At present, there are many domestic and international guidelines for the diagnosis and treatment of sepsis and septic shock. On this basis, China Association of Integrative Medicine Emergency Medicine Committee organized experts to collect evidence-based medical evidence and expert experience in the diagnosis and treatment by integrated Chinese and Western medicine, and referred to the Expert consensus on diagnosis and treatment of sepsis with integrated traditional Chinese and Western medicine published by China Association of Integrative Medicine Emergency Medicine Committee in 2013, developed Expert consensus on diagnosis and treatment of septic shock with integrated traditional Chinese and Western medicine. The consensus provided a "China approach" for the resolution of this worldwide problem. In the "China approach", the staging of septic shock is "longitude", and the "four syndromes and four methods" treatment thought is "latitude". Under the framework of interlaced latitude and longitude, we recommend a series of effective integrated Chinese and Western medicine treatment. The method embodies the wisdom of China and has certain guiding significance for the clinical treatment of septic shock.

Discussion and treatment of bullous pemphigoid from traditional Chinese medicine point of view "lung governing skin and hair" / 中国中西医结合急救杂志

Bullous pemphigoid is a chronic obstinate dermatological disease. Hormone is the main therapeutic method, but the disease course is rather long, relapse is frequently seen and difficult to be radically cured; many complications may occur such as pulmonary infection, etc. From traditional Chinese medicine (TCM) basic principal points of view "lung governing skin and hair" and "strengthen the body resistance to eliminate pathogenic factors", the author explored the TCM therapy of bullous pemphigoid. By using clearing away lung heat and invigorating lung qi as the main principles supplemented by invigorating spleen and kidney, eliminating phlegm and blood stasis for treatment of such disease, relatively satisfactory therapeutic results were obtained.

Research progress of idiopathic systemic capillary leakage syndrome / 中国中西医结合急救杂志

Idiopathic systemic capillary leak syndrome (ISCLS) is a rare disease, the clinical manifestation is increased acute episodic capillary leakage (SCL), leading to protein-rich fluid leakage from the blood vessels to the interstitial tissue space, resulting in progressive systemic edema, hypoproteinemia, hypotension, blood concentration and other clinical symptoms. Because of ISCLS frequent recurrences, high mortality, pathogenesis unclear and no definite treatment plan, it is extremely important to fully understand the disease to carry out early intervention to save the patients' lives. This article reviews the progress of ISCLS, including its disease onset characteristics, clinical features, pathological mechanism, diagnosis and treatment of ISCLS.

Investigation of tick-borne pathogens in Heilongjiang border area / 中华实验和临床病毒学杂志

Objective@#To understand the situation of ticks carrying pathogens in border areas of Heilongjiang province.@*Methods@#From 2009 to 2018, tick specimens were collected in Yichun, Daxing′anling area and Jiamusi in Heilongjiang province. A total of 2 530 ticks were studied, including 800 Ixodes persulcatus and 1 730 Dermacentor silvarum. Tick-borne encephalitis virus (TBEV), severe fever with thrombocytopenia syndrome virus (SFTSV), omsk hemorrhagic fever virus (OHFV), langat virus (LGTV), powassan virus (POWV) were detected by real-time RT-PCR. Spotted fever group rickettsia (SFGR) and Borrelia burgdorferi sensulato (B.b.s.l) were detected by PCR in ticks collected from Jiamusi area.@*Results@#All tick speciments collected were negative for TBEV, SFTSV, OHFV, LGTV and POWV. Tick specimens from Jiamusi carried SFGR and B. b.s.l.with positive rates of 59.5% and 8.9%.@*Conclusions@#The ticks in border areas of Heilongjiang province carry spotted fever group rickettsia and Borrelia burgdorferi, and the carrying rate of spotted fever group rickettsia is high. The monitoring and control of ticks and tick-borne diseases should be strengthened.

The importance of occupational history in clinical thinking from the diagnosis and treatment of a case of Tsutsugamushi disease / 中华劳动卫生职业病杂志

A farm worker in Baodi District of Tianjin was diagnosed with Tsutsugamushi disease due to fever and intermittent cough for more than 3 months.The patient's diagnosis and treatment process was complicated, and the diagnosis was delayed in the early stage of the disease because the clinician neglected the occupational history and lacked knowledge about the prevention and control of tsutsugamushi disease. As an important part of the epidemiological history, occupational history is crucial for the diagnosis of occupational related diseases. Clinical thinking runs through the whole process of clinical diagnosis and disease treatment, and correct clinical thinking can effectively reduce the occurrence of misdiagnosis.Clinicians should ask and record career history in detail to improve the quality of health care.

The experience of treating pulmonary encephalopathy with Angong Niuhuangwan / 中国中西医结合急救杂志

Objective To observe the clinical efficacy of Angong Niuhuangwan on patients with pulmonary encephalopathy, and to provide a theoretical basis of using this pill for treatment of pulmonary encephalopathy. Methods The modern pharmacological effects of Angong Niuhuangwan and the pathogenesis of pulmonary encephalopathy were analyzed, and the clinical efficacy of applying Angong Niuhuangwan for treatment of 3 patients with pulmonary encephalopathy were observed. Results Patient 1, the body temperature dropped after he took 2 Angong Niuhuangwan, and the body temperature had not exceeded 37.1 ℃ within 1 week, consciousness was clear, blood picture was better than before; after patient 2 taking 3 such pills, the consciousness was clear, and the symptoms of asthma and wheezing due to retention of phlegm at throat were significantly better than before; after patient 3 took 3 pills, his body temperature was lowered and the consciousness was better than before. Conclusion Traditional Chinese medicine Angong Niuhuangwan can be used to help treat patients with pulmonary encephalopathy, it can help them improve their respiratory function, avoid mechanical ventilation, significantly elevate their cure rate and ameliorate their sufferings.

The study of serum complements and proinflammatory cytokines in sepsis rats / 中华危重病急救医学

Objective To observe the changes of serum complements and proinflammatory cytokines in rats with sepsis, and to explore the possible mechanism.Methods 120 healthy male Wistar rats were randomly divided into three groups: normal control group (n = 15), sham operation group (n = 15) and sepsis group [cecum ligation and puncture (CLP) operation,n = 90]. The sepsis rats were sacrificed on 24, 48 and 72 hours after modeling. The level of serum complements (C5, C5a) and cytokines tumor necrosis factor-α (TNF-α), interleukin (IL-1, IL-6), high mobility group box 1 (HMGB1), macrophage migration inhibitory factor (MIF) were detected by enzyme linked immunosorbent assay (ELISA).Results Compared with normal control group and sham operation group, the levels of serum complements C5, C5a and IL-1β were significantly increased at 24 hours after CLP in sepsis group [C5 (ng/L): 1.60±0.19 vs. 1.04±0.20, 1.09±0.09; C5a (ng/L): 0.20±0.02 vs. 0.18±0.01, 0.18±0.02; IL-1β (ng/L): 700.20±111.41 vs. 475.87±108.96, 592.29±121.57; allP < 0.05]; then the levels of C5, C5a and IL-1β declined, the level of serum C5 were also higher than normal control group at 48 hours and 72 hours after CLP (ng/L: 1.17±0.24, 1.27±0.24 vs. 1.04±0.20, bothP < 0.05). In sepsis group the level of serum TNF-α (ng/L: 51.33±1.96, 51.06±1.64) was lower than that in normal control group (59.53±3.06) and sham operation group (57.91±2.72) at 48 hours and 72 hours (allP < 0.05). There was a time dependent rise of serum HMGB1 in sepsis group, which level was much higher than that in normal control group and sham operation group at 72 hours after CLP (ng/L: 472.21±20.94 vs. 406.00±43.16, 404.41±35.39, bothP < 0.05). There were no significant differences of MIF, and IL-6 level between groups at each time points.Conclusions Complement system led to uncontrolled inflammatory response and immune dysfunction through the release of proinflammatory cytokines and inflammatory mediators, which maybe one of the important mechanism of the pathology of sepsis.

An observation on clinical effect of quadruple therapy of integrated traditional Chinese and western medicine for treatment of paralytic ileus / 中国中西医结合急救杂志

Objective To observe the clinical effect of the quadruple therapy of integrated traditional Chinese and western medicine for treatment of patients with paralytic ileus.Methods A prospective randomized control trial was conducted.Ninty-five patients with paralytic ileus diagnosed by Tianjin First Central Hospital from January 2015 to February 2016 were randomly divided into a control group (47 cases) and a research group (48 cases).Routine western medical treatment was given to the patients in control group;on the basis of western medical routine treatment,quadruple therapy was applied to the patients in the research group,including alprostadil injection 10 μg,intravenous drip,once a day;Xuebijing injection 40 mL,intravenous drip,twice a day;liangge powder with modification (ingredients or their dosages being added and/or subtracted) composed of rhubarb 10 g,mirabilite 10 g,gardenia 15 g,weeping forsythia 20 g,scutellaria 15 g,glycyrrhiza 6 g,mint 6 g,bamboo leaves 10 g,honey 10 g.administered by gastric tube;point selection principle:zusanli (ST36),sanyinjiao (SP6),tianshu (S25),hegu (LI4),yanglingquan (GB34),zhongwan (CV12),xiawan (CV10),dachangshu (C07)etc.No.30 filiform needle was used to be perpendicularly inserted by moderate and equi-librious acupuncture technique,needle retaining being 30 minutes,once a day for 72 hours.The numbers of the patients with abdominal pain,abdominal distension,nausea and vomiting,absence of exhausting and defecation,gurgling sound attenuation or disappearance,abdominal X-ray abnormality,and the first defecation time,gurgling reappearance time,disappearance time of main symptoms were observed.The clinical effects of these two groups were statistically analyzed.Results After treatment in the two groups,the numbers of patients with abdominal pain,abdominal distension,nausea and vomiting,absence of exhausting and defecation,gurgling sound attenuation or disappearance,abdominal X-ray abnormality were all significantly reduced compared with those before treatment,except the nausea and vomiting symptom,the degrees of descent of other indexes were more remarkable in the research group (abdominal pain:7 cases vs.44 cases,abdominal distension:6 cases vs.45 cases,absence of exhausting and defecation:3 cases vs.48 cases,gurgling sound attenuation or disappearance:11 cases vs.43 cases,abdominal X-ray abnormality:12 cases vs.48 cases),the time of first defecation in research group (hours:22.65 ± 6.72 vs.34.35 ± 5.38),gurgling reappearance time (hours:40.36 ± 6.99 vs.51.33 ± 5.80),symptom disappearance time (hours:51.44 ± 9.41 vs.60.10 ± 5.48) in research group were all shorter significantly than those in control group (all P ＜ 0.05).The total effective rate in the research group was obviously higher than that of the control group [93.75％ (45/48) vs.87.37％ (37/47),P ＜ 0.05].Conclusions The therapeutic effects of the quadruple therapy of integrated traditional Chinese and western medicine are remarkable for treatment of paralytic ileus.

Effect of Liangge powder on expression of inflammatory mediators and hepatic and renal function in rats with sepsis / 中华劳动卫生职业病杂志

Objective@#To investigate the effect of Liangge powder on the expression of inflammatory mediators and hepatic and renal function in rats with sepsis via a preliminary analysis.@*Methods@#A total of 195 Wistar rats were randomly divided into sham-operation group (15 rats) , model group (90 rats) , and treatment group (90 rats) using a random number table, and according to the time point after modeling, the model group and the treatment group were further divided into 24, 48, and 72 hour subgroups, with 30 rats in each subgroup. Cecal ligation and puncture (CLP) was performed to establish a rat model of sepsis, and solid-phase sandwich enzyme-linked immunosorbent assay was used to measure the expression of interleukin-10 (IL-10) , interleukin-1 (IL-1) , interleukin-4 (IL-4) , and lipopolysaccharide (LPS) at 24, 48, and 72 hours after CLP. An automatic biochemical analyzer was used to measure the levels of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , blood urea nitrogen (BUN) , and creatinine (Cr) .@*Results@#Compared with the sham-operation group, the model group had significant increases in the serum levels of IL-1, IL-4, IL-10, LPS, BUN, Cr, AST, and ALT at 24, 48, and 72 hours after CLP (P<0.05) . Compared with the model group, the treatment group had a significant reduction in the serum level of IL-1 at 24, 48, and 72 hours after CLP, a significant increase in the serum level of IL-4 at 24 and 48 hours after CLP, and a significant increase in the serum level of IL-10 and a significant reduction in the serum level of LPS at 24 and 72 hours after CLP (P<0.05) . Compared with the model group, the treatment group had a significant reduction in ALT at 24 hours after CLP, significant reductions in BUN and Cr at 48 hours after CLP, and a significant reduction in AST at 72 hours after CLP (P<0.05) .@*Conclusion@#In the early stage of sepsis, imbalance between pro-inflammation and anti-inflammation and immunosuppression may cause hepatic and renal impairment in rats with sepsis. The traditional Chinese medicine Liangge powder can regulate inflammatory response, restore the balance between pro-inflammation and anti-inflammation, and improve hepatic and renal function in rats with sepsis.

Effects of mecobalamin on Bax and Bcl-2 in neurons after peripheral nerve injury / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To observe the effects of mecobalamin on the expression of apoptosis-related proteins, Bax and Bcl-2, in neurons after peripheral nerve injury, and to explore the role of neuron apoptosis in peripheral nerve regeneration after injury.</p><p><b>METHODS</b>Thirty healthy adult male wistar rats were randomly divided into sham-operation group, model group, and mecobalamin group, with 10 rats in each group. A rat model of left sciatic nerve semi-injury was established using forceps. Rats in the mecobalamin group were fed mecobalamin, while rats in the sham-operation group and model group were given the same dose of normal saline. The protein expression of Bax and Bcl-2 in neurons was measured at 14 days after operation. A semi-quantitative analysis of Bax and Bcl-2 proteins was performed by image analysis technology.</p><p><b>RESULTS</b>The model group had significantly increased Bax protein expression and significantly reduced Bcl-2 protein expression in spinal cord anterior horn motor neurons and ganglion sensory neurons compared with the sham-operation group (P<0.05). Compared with the model group and sham-operation group, the mecobalamin group had significantly reduced Bax protein expression and significantly increased Bcl-2 protein expression in spinal cord anterior horn motor neurons and ganglion sensory neurons (P<0.05).</p><p><b>CONCLUSION</b>Mecobalamin has anti-apoptotic effect, and it contributes to neurological function recovery possibly by inhibiting the death of injured neurons.</p>

Effects of Xuebijing injection on blood coagulation in patients with sepsis / 中国中西医结合急救杂志

Objective To observe the effect of Xuebijing injection on blood coagulation in patients with sepsis. Methods 300 patients with sepsis were randomly divided into control group and Xuebijing injection treatment group(each,150 cases). According to the guidelines of treatment for sepsis,the conventional treatment was given to both groups,and additionally Xuebijing injection 50 mL plus normal saline 100 mL intravenous drip was applied in the treatment group,twice a day for consecutive 7 days. Before treatment and after treatment for 3 days and 7 days,platelet count(PLT),four items of blood coagulation〔prothrombin time(PT),thrombin time(TT),fibrinogen (Fib)and activated partial thromboplastin time(APTT)〕,D-dimer levels and disseminated intravascular coagulation (DIC)incidence were observed in the two groups. Results Before treatment,the levels of Fib,PT,TT,APTT, PLT,D-dimer and the incidence of DIC had no significant differences between the two groups(all P>0.05);after treatment,the levels of PT,TT,APTT,D-dimer and the DIC incidence were significantly lower than those before treatment,while Fib and PLT were significantly enhanced after treatment,and on the 7th day after treatment,the changes in Xuebijing group were more obvious〔Fib(g/L):3.02±0.51 vs. 2.53±0.56,PT(s):13.82±1.91 vs. 16.03±1.68,TT(s):13.85±1.94 vs. 16.03±1.65,APTT(s):39.47±4.73 vs. 42.75±5.24,PLT(×109/L):118.10±15.80 vs. 99.77±15.67,D-dimer(mg/L):3.17±0.26 vs. 3.66±0.50,DIC incidence:5.3%(8/150)vs. 14.0%(21/150),P<0.05 or P<0.01〕. Conclusion Xuebijing injection can improve the hypercoagulable state and reduce the incidence of DIC in patients with sepsis.

Experimental Study-Methycobal Promotes Peripheral Nerve Regeneration / 天津医药

Objective:To investigate the effect of methycobal on peripheral nerve regeneration.Methods:Thirty Wistar rats were divided into normal group(N),model group(M)and methycobal group(B).Each group contained 10 rats.The model of rat with sciatic nerve half injury was made by clamp.Rats were fed with methycobal in B group,and same dose of normal saline was fed in N and M groups.The nerve tissue(silver nitrate stain)and gastrocnemius tissue(HE stain)were obtained to observe the morphologic index,functional index(sciatic nerve function index,differential value of hind legs tensile force,gastrocnemius wet weight index)after 14 days.Results:There were nerve fiber sparseness,disposition disorder,and decrease of gastrocnemius cross section area,sciatic nerve function index,and differential value of hind legs tensile force,gastrocnemius wet weight index diminutu in M group compared with those of N group(P ＜ 0.01).There were more nerve fiber,normal gastrocnemius cross section area,and higher sciatic nerve function index and gastrocnemius wet weight index in B group compared with those of M group(P＜ 0.01),whereas which were also different compared with those of N group(P＜ 0.01).Conclusion:Methycobal can promote the axon growth,postpone sarcous anaiosis of denervation,and enhance functional recovery of peripheral nerve injury.