Analysis of pathogenesis, syndrome differentiation and treatment of asymptomatic infectors of coronavirus disease 2019 based on the theory of "pathogen hiding in the pleurodiaphragmatic interspace" / 中华危重病急救医学

Among coronavirus disease 2019 (COVID-19) patients who infected with 2019 novel coronavirus (2019-nCoV), compared with the symptomatic infection patients, 2019-nCoV carried by asymptomatic infection patients are more likely to be widely spread due to secrecy and neglect, thus brings severe challenges to the current prevention and treatment of COVID-19. The therapies of asymptomatic 2019-nCoV infection are still in research. Through excavating the Chinese medical classics, it was found that the theory of "pathogen hiding in the pleurodiaphragmatic interspace", with its unique syndrome differentiation system and curative effect of treating symptoms and causes, can provide clinical reference for the treatment of asymptomatic 2019-nCoV infections and provide theoretical basis traditional Chinese medicine in the battle against infectious diseases.

Clinical characteristics of patients with dengue fever accompanied by platelet count reduction and analysis of their traditional Chinese medicine syndrome and treatment / 中国中西医结合急救杂志

Objective To analyze the clinical features of patients with dengue fever (DF) accompanied by platelet count (PLT) reduction and their characteristics of traditional Chinese medicine (TCM) syndrome differentiation and treatment. Methods The clinical data of 1 570 patients with confirmed diagnosis of DF collected from the Information Management System (HIS) of the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (TCM) from January 2013 to December 2017 were retrospective analyzed. According to the patients accompanied by platelet (PLT) reduction or not, they were divided into DF accompanied by PLT reduction group (1 211 cases) and non-PLT reduction group (359 cases); according to whether the cooling blood and dissipating blood stasis TCM (composed of red peony, peony bark, rehmannia root, salvia miltiorrhiza, rhinoceros horn, etc.) was used or not in TCM syndrome differentiation prescription, they were divided into cooling blood and dissipating blood stasis group (492 cases) and non-cooling blood and dissipating blood stasis group (719 cases). The differences in clinical characteristics, laboratory indicators, TCM syndrome differentiation and prescription characteristics in DF accompanied by PLT reduction group and non-PLT reduction group were compared and analyzed; the differences in changes of white cell counts (WBC) and PLT levels before and after treatment between cooling blood and dissipating blood stasis group and non-cooling blood and dissipate blood stasis group were compared and analyzed. Results The proportions of rash, hemorrhage, WBC reduction and aspartate transaminase (AST) elevation in DF accompanied by PLT reduction group were significantly higher than those in non-PLT reduction group [rash: 61.4% (744/1 211) vs. 14.8% (53/359), hemorrhage: 7.3% (89/1 211) vs. 1.1% (4/359), WBC reduction: 88.2% (1 068/1 211) vs. 60.4% (217/359), AST increased: 41.0% (497/1 211) vs. 29.5% (106/359)]; the PLT and WBC in the DF accompanied by PLT reduction group were significantly lower than those in the non-PLT reduction group [PLT (×109/L): 74.2±27.5 vs. 166.6±42.8, WBC (×109/L): 2.1±1.6 vs. 6.4±3.7, both P < 0.05], and AST in the DF accompanied by PLT reduction group were significantly higher than those in the non-PLT reduction group (U/L: 69.6±34.1 vs. 52.6±26.1, P < 0.05). The common syndrome of TCM syndrome differentiation in DF accompanied by PLT reduction group and non-PLT reduction group was mainly Wei-Qi syndrome [425 cases (35.1%) and 147 cases (40.9%) respectively]; Yinqiao powder was the main TCM prescription in the two groups [132 cases (10.9%) and 46 cases (12.8%) respectively]. In the comparisons between the cooling blood and dissipate blood stasis group and non-cooling blood and dissipate blood stasis group, there were no statistically significant differences in the proportion of combining use of drugs for increasing WBC and PLT and the levels of WBC and PLT after treatment (all P > 0.05). After treatment, the WBC, PLT levels and the proportions of above indexes returned to normal in the cooling blood and dissipate blood stasis group were significantly higher than those in the non- cooling blood and dissipate blood stasis group [WBC(×109/L): 4.5±3.1 vs. 3.2±2.4, proportion of WBC returned to normal: 42.7% (210/492) vs. 33.1% (238/719); PLT (×109/L): 85.9±26.2 vs. 79.3±24.8, proportion of PLT returned to normal: 41.1% (202/492) vs. 27.5% (198/719), all P < 0.05]. Conclusions The symptoms of skin rash and bleeding are more common in patients with DF accompanied by PLT reduction. The syndrome differentiation of TCM for this disease is mostly based on the combined disorders of Wei (defence) and Qi, both Qi and blood burning and blood stasis associated with toxin. Cooling blood and dissipating blood stasis may help the recovery of WBC and PLT in these patients, which is of great significance in reducing severity of dengue fever (such as bleeding).

Prognostic value of procalcitonin and C-reactive protein combined with sequential organ failure assessment score in elderly patients with sepsis induced by pulmonary infection / 中华危重病急救医学

Objective To investigate the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) combined with sequential organ failure assessment (SOFA) score in elderly patients with sepsis induced by pulmonary infection. Methods A retrospective study was conducted. The elderly patients aged over 60 years old with sepsis induced by pulmonary infection admitted to Guangdong Provincial Hospital of Chinese Medicine from October 2015 to December 2018 were enrolled. The PCT, CRP and SOFA scores of patients within 24 hours after admission and 28-day prognosis were recorded. The patients were divided into groups according to the severity of the disease and 28-day prognosis. The differences in above parameters among all the groups were compared. Receiver operator characteristic (ROC) curve was drawn to analyze the prognostic value of the above indicators in elderly patients with sepsis induced by pulmonary infection alone or in combination. Results A total of 265 patients were enrolled in the study. According to the severity of the disease, the patients were divided into sepsis group (n = 194) and septic shock group (n = 71). According to the 28-day prognosis, the patients were divided into survival group (n = 186) and non-survival group (n = 79). Compared with the sepsis group, the PCT, CRP and SOFA scores of patients in the septic shock group were significantly increased [PCT (μg/L): 6.16 (1.94, 19.60) vs. 1.56 (0.34, 7.32), CRP (mg/L): 128.90 (54.93, 198.70) vs. 91.45 (30.15, 175.30), SOFA score: 9.0 (7.0, 12.0) vs. 4.0 (3.0, 5.0)] with significant differences (all P < 0.05). Compared with the survival group, the PCT, CRP and SOFA scores of sepsis patients in the non-survival group were significantly increased [PCT (μg/L): 4.80 (1.06, 19.60) vs. 1.82 (0.34, 7.24), CRP (mg/L): 135.20 (58.10, 225.50) vs. 91.45 (31.50, 172.53), SOFA score: 7.0 (4.0, 11.0) vs. 4.0 (3.0, 6.0)] with significant differences (all P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) of PCT, CRP, SOFA score and CRP+PCT+SOFA score was 0.641, 0.607, 0.697, and 0.712, indicating that above parameters had certain predictive value for 28-day prognosis of elderly patients with sepsis induced by pulmonary infection, and the combined predictive value of them was the greatest with the sensitivity of 55.1% and the specificity of 80.1%. Conclusion PCT, CRP and SOFA score are commonly used to evaluate the prognosis of the elderly patients with sepsis induced by pulmonary infection, and the combination of them has higher evaluation value.

Preliminary discussion on emergency early diagnosis of atypical acute aortic dissection / 中国中西医结合急救杂志

Acute aortic dissection (AAD) is a cardiovascular critical serious disease, and the clinical manifestations of AAD are diverse and complicated. The emergent early diagnosis is often challenging, and misdiagnosis or delay in diagnosis may result in serious consequences. The process of diagnosis and treatment of a patient with Stanford A type AAD firstly manifesting atypical signs and symptoms of osphyalgia and paraplegia was retrospectively analyzed. The related literatures were reviewed to discuss the early diagnostic strategies used in this atypical emergent patient with AAD.

Migraine without aura treated with balance acupuncture therapy:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To assess the effect of balance acupuncture for migraine without aura.</p><p><b>METHODS</b>Blind evaluation was conducted. Forty patients with migraine without aura were randomized into an observation group and a control group, 19 cases in each one with 1 patient dropped out respectively. In the observation group,, the middle point was used in the hollow before the 1, 2 metatarsal combination, and in the control group, a sham point was applied in the hollow before the 3, 4 metatarsal combination. The manipulation in the two groups was the same. The treatment was given for 4 weeks, once a day, 5 times a week. The comprehensive score and visual analogue scale (VAS) were used before and after treatment, as well as 4 weeks after treatment.</p><p><b>RESULTS</b>The comprehensive score and VAS score after treatment in the observation group decreased after treatment (both<0.05), of which the total headache time and attack number for one month were lower than those before treatment (both<0.05), but at follow-up the VAS score was higher than that after treatment (<0.05). The above indices in the control group were not significantly different from those before treatment (all>0.05). All the indices in the observation group after treatment and at follow-up were lower than those in the control group (all<0.05). The different values for the comprehensive score and VAS score before and after treatment, before treatment and at follow-up in the observation group were better than those in the control group (all<0.05). The different values after treatment and at follow-up had no significant difference between the two groups (both>0.05).</p><p><b>CONCLUSIONS</b>Balance acupuncture atachieves obvious effect for migraine without aura, which can relieve pain.</p>

Exploration of Traditional Chinese Medical Syndrome Differentiation and Treatment for Dengue Fever：An Analysis of 257 Cases / 广州中医药大学学报

Objective To explore the etiology, pathogenesis, syndrome differentiation and treatment for dengue fever according to the theory of traditional Chinese medicine ( TCM) . Methods A retrospective case analysis was carried out in 257 dengue fever patients admitted in 2013 by Guangdong Provincial Hospital of Traditional Chinese Medicine. The clinical data of pathogenic features, TCM symptoms and signs, and therapeutic regimen were collected and analyzed. Results Six commonly-seen TCM syndrome patterns for dengue fever were classified into disease involving both defensive system and Qi system, excessive heat in defensive system, summer-heat and dampness stagnating the middle-jiao or attacking the exterior, excessive heat in both Qi system and blood system, pathogenic factors lodging between diaphragm and pleura, and mixture of blood stasis and toxicity, and the corresponding prescriptions were Yinqiao Powder, Chaige Jieji Decoction, Xinjia Xiangru Decoction, Qingwen Baidu Decoction, Dayuan Decoction, Xijiao Dihuang Decoction, respectively. Conclusion The TCM syndrome patterns of dengue fever in Guangzhou area are characterized as excessive heat in Qi system, complicated with nutrient and blood system syndrome, and mostly are blended with dampness. Correspondingly, the therapeutic principles should be clearing heat and removing toxicity in Qi system with cold-cool herbs, and assisting with cooling blood to clear heat in Qi system and removing dampness.