Effect of fluoxetine combined with Shugan Jieyu capsule in the treatment of patients with depression and its impact on heart rate variability / 四川精神卫生

BackgroundDepression is a kind of disease with relatively high suicide risk， which seriously affects the quality of life of patients and their families， and brings a great burden to society. Antidepressants in western medicine are effective， but the improvement of depressive symptoms is relatively limited by single use， and the combination of two antidepressants may increase the risk of adverse reactions in patients. The rational use of Chinese patent medicine and western medicine may play a complementary role， and the safety of Chinese patent medicine is high. ObjectiveTo explore the early clinical efficacy of fluoxetine combined with Shugan Jieyu capsule in the treatment of depression， and to compare the differences in efficacy， safety and influence on heart rate variability between fluoxetine combined with Shugan Jieyu capsule and fluoxetine alone， so as to provide references for clinical medication of depression patients. MethodsFrom December 2015 to June 2016， 64 patients who met the diagnostic criteria of depression in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） who were hospitalized in the Second Affiliated Hospital of Xinxiang Medical University were selected as the research objects， and were randomly divided into the combined medication group and the fluoxetine group with 32 patients in each group. Patients in both groups were treated with fluoxetine， while patients in the combined medication group were treated with Shugan Jieyu capsule on this basis. Patients in both groups were assessed with Hamilton Depression Scale-24 item （HAMD-24）， Hamilton Anxiety Scale （HAMA） and Heart Rate Variability （HRV） before treatment， and were assessed with HAMD-24 and Treatment Emergent Symptom Scale （TESS） at the end of the 2nd， 4th and 6th week of treatment， and HRV was analyzed again at the end of the 6th week of treatment. ResultsThe study ultimately included 60 patients with depression， with 30 cases in the combination therapy group and 30 cases in the fluoxetine group. At the end of the 2nd， 4th and 6th week of treatment， the HAMD-24 score of the combined drug group was lower than that of the fluoxetine group （t=-2.677， -3.960， -4.432， P<0.05 or 0.01）. Compared with before treatment， the 24-hour mean standard deviation of normal RR intervals （SDNN）， normal low frequency （nLF） and normal high frequency （nHF） in the combined treatment group were higher at the end of the 6th week （t=-73.970， -31.878， -38.721， P<0.01）， but significant lower in LF/HF （t=3.525， P<0.01）. At the end of the 6th week of treatment， the total effective rate of the combined treatment group was higher than that of fluoxetine group， and the difference was statistically significant （86.67% vs. 70.00%， χ2=18.764， P<0.01）. At the 2nd， 4th and 6th week of treatment， there was no significant difference in the number of adverse reactions between the two groups （P>0.05）. ConclusionCompared with fluoxetine alone， Shugan Jieyu capsule combined with fluoxetine may be better in clinical efficacy and improvement of heart rate variability in patients with depression， without increasing adverse reactions.

Genome-wide DNA methylation and transcriptome expression profiles of peripheral blood mononuclear cells in patients with systemic sclerosis with interstitial lung disease / 中南大学学报(医学版)

OBJECTIVES@#This study aims to investigate the genome-wide DNA methylation and transcriptome expression profiles of peripheral blood mononuclear cells (PBMCs) in patients with systemic sclerosis (SSc) with interstitial lung disease (ILD), and to analyze the effects of DNA methylation on Wnt/β-catenin and chemokine signaling pathways.@*METHODS@#PBMCs were collected from 19 patients with SSc (SSc group) and 18 healthy persons (control group). Among SSc patients, there were 10 patients with ILD (SSc with ILD subgroup) and 9 patients without ILD (SSc without ILD subgroup). The genome-wide DNA methylation and gene expression level were analyzed by using Illumina 450K methylation chip and Illumina HT-12 v4.0 gene expression profiling chip. The effect of DNA methylation on Wnt/β-catenin and chemokine signal pathways was investigated.@*RESULTS@#Genome-wide DNA methylation analysis identified 71 hypermethylated CpG sites and 98 hypomethylated CpG sites in the SSc with ILD subgroup compared with the SSc without ILD subgroup. Transcriptome analysis distinguished 164 upregulated genes and 191 downregulated genes in the SSc with ILD subgroup as compared with the SSc without ILD subgroup. In PBMCs of the SSc group, 35 genes in Wnt/β-catenin signaling pathway were hypomethylated, while frizzled-1 (FZD1), mitogen-activated protein kinase 9 (MAPK9), mothers against DPP homolog 2 (SMAD2), transcription factor 7-like 2 (TCF7L2), and wingless-type MMTV integration site family, member 5B (WNT5B) mRNA expressions were upregulated as compared with the control group (all P<0.05). Compared with the SSc without ILD subgroup, the mRNA expressions of dickkopf homolog 2 (DKK2), FZD1, MAPK9 were upregulated in the SSc with ILD subgroup, but the differences were not statistically significant (all P>0.05). In PBMCs of the SSc group, 38 genes in chemokine signaling pathway were hypomethylated, while β-arrestin 1 (ARRB1), C-X-C motif chemokine ligand 10 (CXCL10), C-X-C motif chemokine ligand 16 (CXCL16), FGR, and neutrophil cytosolic factor 1C (NCF1C) mRNA expressions were upregulated as compared with the control group (all P<0.05). Compared with the SSc without ILD subgroup, the mRNA expressions of ARRB1, CXCL10, CXCL16 were upregulated in the SSc with ILD subgroup, but the differences were not statistically significant (all P>0.05).@*CONCLUSIONS@#There are differences in DNA methylation and transcriptome profiles between SSc with ILD and SSc without ILD. The expression levels of multiple genes in Wnt/β- catenin and chemokine signaling pathways are upregulated, which might be associatea with the pathogenesis of SSc.

Mortality trend of inpatients with connective tissue diseases: 2005-2014 / 中南大学学报(医学版)

Objective:To analyze the trend relevant factors leading to death and their patterns over a 10-year period in inpatients with connective tissue diseases (CTDs).Methods:All clinical data about death in inpatients with CTDs were retrospectively reviewed between 2005 and 2014 at the Department of Rheumatology and Immunology in Xiangya Hospital of Central South University.Results:In the 10-year time period,the overall hospital mortality was 15.689‰.The disease itself accounted for 44.71% of the total causes of death,infection accounted for 42.94%,and comorbidities accounted for 12.35%.The constituent ratio of deaths and the average hospital mortality caused by the disease itself declined gradually year by year,and the constituent ratio of deaths caused by infection and comorbidities increased gradually year by year (P<0.05).In 2013-2014,infection was the leading cause of death,which accounted for 51.06%.The survival time for CTDs inpatients with interstitial lung disease (ILD) was shorter than that of CTDs inpatients without ILD,and even the risk of death was 1.722 times of the latter.The proportion of deaths caused by the disease itself was the highest in systemic sclerosis and systemic lupus erythematosus,that by infection was the highest in idiopathic inflammatory myopathy (IIM),and that by comorbidities was the highest in rheumatoid arthritis.Conclusion:The proportion of deaths and the hospital mortality in CTDs inpatients caused by the disease itself show a declining trend,while the proportion of deaths caused by infection and comorbidities increase.CTDs patients with ILD have shorter survival time and an increase in risk of death.

Application of the standardization management form of the totally implanted vascular access devices / 中国实用护理杂志

Objective To strengthen the standardized management of totally implanted vascular access devices (TIVAD) in order to prevent and reduce the complications.Methods The unified TIVAD maintenance record form was adopted.The form contained the embedded and maintenance information.The maintenance and propaganda handbooks were handed out to the patients.The incidence of complications between before and after the application of the maintenance record form was analyzed statistically.Results The incidence of infection and obstruction fell from 2.1％(20/942) and 8.3％(78/942) to 1.0％(13/1 258) and 2.8％(35/1 258),the difference was statistically significant.Conclusions The application of TIVAD maintenance record form can reduce the occurrence of complications and prolong the service life of TIVAD.

Application of somatostatin in expectant treatment for postoperative chylothorax in children after congenital heart disease surgery / 中华实用儿科临床杂志

Objective To investigate the therapeutic efficacy of somatostatin on chylothorax after congenital heart disease surgery in children.Methods Retrospective analysis was performed in 13 postoperative chylothorax cases from Jan.2003 to Dec.2012,who were divided into control group (n =6) and treatment group (n =7),and there was no significant difference in age,weight,and time of occurrence between the 2 groups.The diagnosis standard for chylothorax was the same.The changes of chylous volume during the treatment were analyzed between 2 groups,and healing time and other data were analyzed too.Results Control group:clinical cure in 3 cases,conservative treatment failed in 3 cases(2 cases recovered after operation and 1 case died).The chyle volume of control group reduced obviously compared with post treatment from beginning [(256.6 ± 124.2) mL/d] to 1 week [(155.5 ± 85.7) mL/d] and 2 weeks [(142.3 ± 110.3) mL/d] later(t =4.623,2.099 ; P =0.002,0.044).But it did not reduce obviously in 3 weeks later[(139.4 ± 113.4) mL/d] (t =1.745,P =0.07).Treatment group:6 cases in treatment group were successful in recovery after conservative treatment and 1 case underwent operation.The chyle volume of treatment group reduced obviously compared with post treatment from beginning to 1 week [(51.2 ± 18.7) mL/d] and 2 weeks [(19.3 ± 7.05) mL/d] later (t =5.549,6.638 ;P =0.001,0.001).Compared with the control group,the difference between 2 groups in post treatment (1 week later,2 weeks hater) was of statistical significance (t =2.900,2.412 ; P =0.014,0.034).The healing time of conservative treatment in 2 groups (only for recovery) had obvious difference [(32.8 ± 1.8) d,(25.2 ± 1.7) d] (t =2.512,P =0.028).Conclusions The use of somatostatin can significantly promote the recovery of chylothorax in children,and it should be actively used in early conservative treatment.

Clinical study of invasive fungal infection secondary to systemic lupus erythematosus / 中南大学学报(医学版)

OBJECTIVE@#To study the clinical characteristics of invasive fungal infection secondary to systemic lupus erythematosus (SLE).@*METHODS@#We observed the clinical features and experimental examination in 91 patients treated in Xiangya Hospital in recent years, of which 48 patients with invasive fungal infection and 41 patients without invasive fungal infection.@*RESULTS@#The invasive fungal infection secondary to SLE mainly occurred in the lungs, nervous system, and urinary system. The fungi were mainly Candida albins and Aspergillus. The rate of invasive fungal infection in SLE patients and the level of CRP and TNF-α in these patients were significantly increased. The occurrence of invasive fungal infection was positively correlated with the prolonged course of disease, long-term use of immunosuppressants and antibiotics, and occurrence of complications, such as hypoproteinemia, leukocytopenia, and so on. The levels of C-reactive protein (CRP) and tumor necrosis factor-α(TNF-α) were increased in SLE patients with invasive fungal infection.@*CONCLUSION@#The clinical features of SLE patients with invasive fungal infections are long course of disease, long-time use of immunosuppressants or antibiotics, and occurrence of complications, such as hypoproteinemia or leukopenia. The level of CRP and TNF-α can be used as an important reference index for diagnosing invasive fungal infections.

Pathogenic bacteria distribution and clinical analysis of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery / 中华急诊医学杂志

Objective To investigate pathogen bacteria distribution and clinical analysis of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery for guiding the rational clinical use of antimicrobial drugs.Methods The clinical data of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery were retrospectively analyzed for microbiologically documented infection.Bacterial identification was performed in an automatic VITEK2Jr expression system and antimicrobial susceptibility testing by Kirby2Bauer method.The results of antimicrobial susceptibility testing were performed in WHONET 5.0 system software.Results There were 16 strains of pathogenic bacteria in 2010,Gram-negative bacteria 9 stains (Klebsiella pneumoniae 18.75％,Acinetobacter baummannii 12.5％),gram positive coccus 6strains (Streptococcus 18.75％),Fungi 1 strain.There were 32 strains of pathogenic bacteria in 2011,Gram-negative bacteria 24 stains (Acinetobacter baummannii 31.25％,Klebsiella pneumoniae 25％,Pseudomonas aeruginosa 6.25％),gram positive coccus 8 strains (Enterococcus 12.5％,Streptococcus 6.25％).There were 42 strains of pathogenic bacteria in 2012,Gram-negative bacteria 38 stains (Acinetobacter baummannii 26.19％,Klebsiella pneumoniae33.33％,Pseudomonas aeruginosa 21.42％),gram positive coccus 4 strains (Enterococcus 4.76％).Acinetobacter baummannii remained highly sensitive to Amikacin and Levofloxacin,highly resistant to Meropenem,Imipenem,Klebsiella pneumonia remained highly sensitive to Amikacin and Levofloxacin,highly resistant to Cefoperazone/Sulbactam,Meropenem,Imipenem,trimethoprim-sulfamethoxazole,Ciprofloxacin.Pseudomonas aeruginosa only remained sensitive to Levofloxacin and Piperacillin/Tazobactam.Gram-positive cooci proportion in pathogenic bacteria decreased year by year,Streptococcus and Enterococcus had major proportion in Gram-positive cooci,Staphylococci decreased,There was no Staphylococcus,Enterococcus and Staphylococci resistant to vancomycin.Conclusions Gram-negative bacteria was the major pathogenic bacteria in ventilator-associated pneumonia with congenital heart disease postoperative infants and young children,Acinetobacter baummannii Klebsiella pneumoniaeand Pseudomonas aeruginosa had major proportion in gram-negative bacteria and drug resistance increased.Rational use of antibacterials was very important to reduce drug resistant strains.

Time to Start Rehabilitation after Mastectomy for Affected Limb Function / 中国康复理论与实践

Objective To explore the effect of rehabilitation training start time after mastectomy on the recovery of the affected limb function. Methods 90 patients who received modified radical mastectomy were divided into groups A, B and C randomly. All the patients ac-cepted the unified rehabilitation program, but started 1, 3 and 10 d after the operation respectively. They were evaluated with the Japanese Orthopaedics Association (JOA) assessment for affected shoulder 1, 3 and 6 months after operation. Results The score of JOA was the least in the group C (P0.05). Conclusion The rehabilitation training can be started as early as possible.

Two cases of lupus cystitis and literature review / 中南大学学报(医学版)

OBJECTIVE@#To improve the understanding of lupus cystitis.@*METHODS@#Clinical manifestations, laboratory Results , and image information of 2 cases of lupus cystitis were analysed retrospectively, and another 6 cases in the literature were reviewed.@*RESULTS@#Two patients were female. The urinary symptoms followed the gastrointestinal symptoms. Ureterectasia and hydronephrosis were detected in both patients, and intestinal pseudo-obstruction was detected in one patient. In the 6 cases from the literature, ureterectasia and hydronephrosis were detected in all patients, and intestinal pseudo-obstruction was detected in 4.@*CONCLUSION@#The possibility of lupus cystitis should be considered when lupus patients complain of urinary or bowel symptoms. Glucocorticoid and immunodepressant are effective for lupus cystitis.