Qingxin Zishen Decoction Treats Menopausal Syndrome Due to Yin Deficiency with Effulgent Fire by Regulating KNDy Neurons / 中国实验方剂学杂志

ObjectiveTo explore the comprehensive effects of Qingxin Zishen decoction on the symptom score and neuroendocrine indexes and the mechanism of the decoction in regulating KNDy neurons in the patients with menopausal syndrome. MethodA total of 60 patients with menopausal syndrome due to yin deficiency with effulgent fire who attended the menopausal outpatient of Jiangsu Province Hospital of Chinese Medicine were randomized into an experimental （Qingxin Zishen decoction） group （30 cases） and a control （femoston） group （30 cases）. The treatment lasted for 12 weeks in both groups. The two groups were compared in terms of the comprehensive efficacy， frequency and degree of hot flashes and sweating， modified Kupperman score， and the serum levels of hypothalamic peptide kisspeptin， neurokinin B （NKB）， dynorphin （Dyn）， follicle-stimulating hormone （FSH）， and estradiol （E2）. Result① Comprehensive efficacy： The comprehensive efficacy of the two groups was comparable. ② Frequency and degrees of hot flashes and sweating： After treatment， the frequency and degrees of hot flashes and sweating in the two groups were reduced （P<0.05） and the control group outperformed the experimental group （P<0.05）. ③ Modified Kupperman score and menopausal symptoms： After treatment， the modified Kupperman score decreased in both groups （P<0.05）. After 4 weeks of treatment， the experimental group was superior to the control group in terms of the scores of dizziness and headache （P<0.05）. ④ Serum levels of sex hormones： After treatment， the serum E2 level elevated and the FSH level lowered in both groups （P<0.05）， and the changes were more obvious in the control group （P<0.05）. ⑤ Neuroendocrine indexes： After treatment， the serum levels of kisspeptin and NKB in the two groups decreased （P<0.05）， and the serum Dyn level in the experimental group increased （P<0.05）. Moreover， the experimental group had higher Dyn level than the control group after treatment （P<0.05）. ConclusionQingxin Zishen decoction can alleviate hot flashes， sweating， and other symptoms in the women with menopausal syndrome by acting on the KNDy neurons to lower the kisspeptin and NKB levels and elevate the Dyn level. The findings provide new ideas for the clinical treatment of hot flashes in menopause.

Síndrome neuroléptico maligno

El síndrome neuroléptico maligno (SNM) es una reacción adversa medicamentosa potencialmente fatal asociada comúnmente a medicamentos antipsicóticos. Este artículo presenta una revisión actualizada sobre el SNM, aborda su epidemiología, factores de riesgo, presentación clínica, posibles mecanismos subyacentes y tratamiento. Se busca mejorar el reconocimiento temprano, diagnóstico y manejo del SNM en el ámbito clínico para reducir su morbimortalidad. La búsqueda de literatura se realizó en PubMed, fueron priorizados ensayos aleatorizados, revisiones sistemáticas, estudios retrospectivos y reportes de caso. La incidencia del SNM ha disminuido en los últimos años, posiblemente debido a una mejor prescripción y titulación de la medicación. Los factores de riesgo incluyen el uso de antipsicóticos de alta potencia, dosis elevadas, incremento rápido de la dosis y uso de antipsicóticos inyectables de depósito. Se han identificado factores ambientales como la deshidratación, sujeción mecánica y temperaturas extremas. Algunas características psicopatológicas, como la agitación psicomotriz y la confusión, también se han asociado al SNM. Los factores hereditarios y los polimorfismos genéticos pueden influir en la susceptibilidad al SNM, pero se requieren estudios adicionales. La fisiopatología del SNM se relaciona con el bloqueo excesivo de los receptores dopaminérgicos, pero otros cofactores y sistemas neurotransmisores también podrían estar involucrados. El cuadro clínico del SNM se caracteriza por cambios en el estado mental, rigidez muscular, hipertermia, síntomas catatónicos y sudoración profusa. Existen diversas formas de tratamiento, desde medidas generales hasta intervenciones farmacológicas.

The Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse drug reaction commonly associated with antipsychotic medications. This article presents an updated review of NMS, addressing its epidemiology, risk factors, clinical presentation, possible underlying mechanisms, and treatment. The aim is to improve early recognition, diagnosis, and management of NMS in the Peruvian clinical setting to reduce morbidity and mortality. The literature search was conducted in PubMed, prioritizing randomized studies, systematic reviews, retrospective studies, and case reports. The incidence of NMS has decreased in recent years, possibly due to better medication prescription and titration. Risk factors include the use of high-potency antipsychotics, high doses, rapid dose escalation, and the use of depot injectable antipsychotics. Environmental factors such as dehydration, mechanical restraint, and extreme temperatures have been identified. Some psychopathological characteristics, such as psychomotor agitation and confusion, have also been associated with NMS. Genetic factors and genetic polymorphisms may influence susceptibility to NMS, but further studies are needed. The pathophysiology of NMS is related to excessive blockade of dopaminergic receptors, but other cofactors and neurotransmitter systems may be involved. The clinical presentation of NMS is characterized by changes in mental status, muscle rigidity, hyperthermia, catatonic symptoms, and profuse sweating. There are various treatment approaches ranging from general measures to pharmacological interventions.

Impacto psicológico de la hiperhidrosis primaria / Psychological impact of primary hyperhidrosis / Impacto psicológico da hiperidrose primária

La hiperhidrosis primaria es una patología frecuente que representa un motivo de consulta dermatológica común, se caracterizada por una sudoración excesiva en regiones axilares, plantares, palmares o craneofaciales que aparece generalmente en la pubertad o en la adolescencia, sus portadores con frecuencia desarrollan discapacidad psicológica como síntomas de depresión, ansiedad y auto aislamiento social. Objetivo. Identificar el impacto la hiperhidrosis primaria produce en la calidad de vida de los pacientes, mediante el análisis de la efectividad de tratamientos disponibles para la mejora de síntomas generados antes su padecimiento. Metodología. En la revisión sistemática se recopiló información científica en Pubmed, Scopus y Taylor & Francis, la información obtenida fue de artículos originales y metaanálisis comprendido entre enero de 2011 a diciembre de 2022, la ecuación de búsqueda "hiperhidrosis", "psicología", "salud mental" y "calidad de vida. Resultados. Se obtuvo 127 fuentes entre PubMed, Scopus, Taylor & Francis, se revisó y eliminó los duplicados y los artículos carentes de información de interés, seleccionando 41 artículos, y posteriormente se aplicó a los artículos restantes los criterios de inclusión y exclusión, obteniéndose finalmente 8 artículos para el análisis. Conclusión. El principal impacto psicológico de la hiperhidrosis primaria es la ansiedad y la depresión, las cuales se pueden evidenciar con mayor prevalencia en pacientes de sexo femenino y la repercusión principal en la vida diaria es el aislamiento social, donde el apoyo de sus familiares juega un papel importante en las recuperaciones del paciente, además se desconoce la causa directa de la enfermedad, siendo su causa multifactorial.

Primary hyperhidrosis is a common pathology that represents a common reason for dermatologic consultation, characterized by excessive sweating in axillary, plantar, palmar or craniofacial regions that usually appears at puberty or adolescence, its carriers often develop psychological disability such as symptoms of depression, anxiety and social self-isolation. Objective. To identify the impact of primary hyperhidrosis on the quality of life of patients, by analyzing the effectiveness of available treatments for the improvement of symptoms generated before the condition. Methodology. In the systematic review, scientific information was collected in Pubmed, Scopus and Taylor & Francis, the information obtained was from original articles and meta-analysis from January 2011 to December 2022, the search equation "hyperhidrosis", "psychology", "mental health" and "quality of life". Results. We obtained 127 sources among PubMed, Scopus, Taylor & Francis, reviewed and eliminated duplicates and articles lacking information of interest, selecting 41 articles, and then applied the inclusion and exclusion criteria to the remaining articles, finally obtaining 8 articles for analysis. Conclusion. The main psychological impact of primary hyperhidrosis is anxiety and depression, which are more prevalent in female patients, and the main repercussion in daily life is social isolation, where the support of family members plays an important role in the patient's recovery, and the direct cause of the disease is unknown, being its cause multifactorial.

A hiperidrose primária é uma patologia comum que representa um motivo frequente de consulta dermatológica, caracterizada por sudorese excessiva nas regiões axilar, plantar, palmar ou craniofacial, que geralmente aparece na puberdade ou na adolescência, e seus portadores frequentemente desenvolvem deficiência psicológica, como sintomas de depressão, ansiedade e autoisolamento social. Objetivo. Identificar o impacto da hiperidrose primária na qualidade de vida dos pacientes, analisando a eficácia dos tratamentos disponíveis para a melhora dos sintomas gerados antes da doença. Metodologia. Na revisão sistemática, foram coletadas informações científicas no Pubmed, Scopus e Taylor & Francis, as informações obtidas foram de artigos originais e meta-análises entre janeiro de 2011 e dezembro de 2022, a equação de busca "hyperhidrosis", "psychology", "mental health" e "quality of life". Resultados. Obtivemos 127 fontes do PubMed, Scopus, Taylor & Francis, revisamos e eliminamos duplicatas e artigos sem informações de interesse, selecionando 41 artigos e, em seguida, aplicamos os critérios de inclusão e exclusão aos artigos restantes, obtendo finalmente 8 artigos para análise. Conclusão. O principal impacto psicológico da hiperidrose primária é a ansiedade e a depressão, que são mais prevalentes em pacientes do sexo feminino, e a principal repercussão na vida diária é o isolamento social, em que o apoio dos familiares desempenha um papel importante na recuperação do paciente. Além disso, a causa direta da doença é desconhecida, pois é multifatorial.

Concept Analysis of the Nursing Diagnosis of Impaired Spontaneous Ventilation in Critical Patients / Análisis de concepto del diagnóstico de la ventilación espontánea deteriorada en pacientes críticos / Análise conceitual do diagnóstico de ventilação espontânea prejudicada em pacientes críticos

Introduction: In nursing practice, this concept has been identified in studies that address the nursing diagnosis of impaired spontaneous ventilation. Nursing performance facing this unwanted human response is considered essential for the maintenance and control of vital signs, cardiovascular monitoring, gas exchange and respiratory pattern, as well as constant surveillance aimed at signs of hypoventilation and inadequate ventilation. Objective: To analyze the concept of impaired spontaneous ventilation in critically ill patients in an intensive care unit. Methodology: This study is a concept analysis, according to Walker's and Avant's method, conducted using an integrative review. All the referential steps were followed: concept selection, determining the objectives and proposals for concept analysis, identifying the possible uses of the concept, determining the defining attributes, identifying a model case, identifying a contrary case, and identifying the precedents and consequences of the concept. Results: A sample of 38 studies was selected. The following were identified as attributes: distress and fatigue, respiratory distress, tachycardia, hemodynamic instability, altered mental status, abnormal arterial blood gas results, dyspnea, anxiety, agitation, sweating, hypoxemia and hypercapnia. Antecedents: sex, age, oxygen saturation lower than 90%, diseases of the respiratory, cardiovascular, neurological, gastrointestinal, neuromuscular, and metabolic systems, respiratory infections, trauma, poisons, toxins, and sedatives. Consequences: increased heart rate, decreased partial oxygen saturation, increased use of respiratory muscles, dyspnea, increased metabolic rate and restlessness. The model case and the contrary case were used to illustrate the attributes, antecedents, and consequences. Conclusion: The study directed the strengthening of evidence about the phenomenon and demonstrated a strong occurrence in patients who need assistance in intensive care units, thus demanding critical care.

Introducción: en la práctica de enfermería, este concepto fue identificado en estudios que abordan el diagnóstico de la ventilación espontánea deteriorada. La actuación desde enfermería para enfrentar esta indeseada respuesta humana es esencial para el mantenimiento y el control de los signos vitales, el monitoreo cardiovascular, el intercambio de gases y el patrón de respiración, así como para la vigilancia constante de los signos de hipoventilación y ventilación inadecuada. Objetivo: analizar el concepto de ventilación espontánea deteriorada en pacientes críticos en una unidad de cuidado intensivo. Metodología: Este estudio es un análisis de concepto, de acuerdo con el método de Walker y Avant, conducido usando una revisión integrada. Se siguieron todos los pasos referenciales: selección del concepto, determinación de los objetivos y propuestas para el análisis de conceptos, identificación de los posibles usos del concepto, determinar los atributos definitorios, identificación del caso modelo, identificación del caso contrario e identificación de precedentes y consecuencias del concepto. Resultados: se seleccionó una muestra de 38 estudios. Se identificaron como atributos: angustia y fatiga, dificultad respiratoria, taquicardia, inestabilidad hemodinámica, estado mental alterado, gasometría arterial anormal, disnea, ansiedad, agitación, sudoración, hipoxemia e hipercapnia. Antecedentes: sexo; edad; saturación de oxígeno inferior al 90%; enfermedades de los sistemas respiratorio, cardiovascular, neurológico, gastrointestinal, neuromuscular y metabólico; infecciones respiratorias; traumatismos, y venenos, toxinas y sedantes. Consecuencias: aumento del ritmo cardíaco, disminución de la saturación parcial de oxígeno, aumento del uso de los músculos respiratorios, disnea, aumento del índice metabólico e inquietud. Se utilizaron el caso modelo y el caso contrario para ilustrar los atributos, antecedentes y consecuencias. Conclusión: el estudio dirigió el fortalecimiento de la evidencia sobre el fenómeno y demostró una fuerte ocurrencia en pacientes que necesitan asistencia en unidades de cuidados intensivos, quienes requieren, en consecuencia, de cuidados críticos.

Introdução: na prática da enfermagem, esse conceito foi identificado em estudos que abordaram o diagnóstico de ventilação espontânea prejudicada. A atuação da enfermagem para enfrentar essa resposta humana indesejável é essencial para a manutenção e o controle dos sinais vitais, da monitorização cardiovascular, das trocas gasosas e do padrão respiratório, bem como para a vigilância constante dos sinais de hipoventilação e ventilação inadequada. Objetivo: analisar o conceito de ventilação espontânea prejudicada em pacientes graves internados em uma unidade de terapia intensiva. Materiais e método: este estudo é uma análise conceitual, de acordo com o método de Walker e Avant, realizada por meio de uma revisão integrada. Todas as etapas referenciais foram seguidas: seleção do conceito, determinação dos objetivos e proposições para a análise do conceito, identificação dos possíveis usos do conceito, determinação dos atributos definidores, identificação do caso-modelo, identificação do contracaso e identificação dos precedentes e consequências do conceito. Resultados: foi selecionada uma amostra de 38 estudos. Os atributos identificados foram angústia e fadiga, angústia respiratória, taquicardia, instabilidade hemodinâmica, estado mental alterado, gases sanguíneos arteriais anormais, dispneia, ansiedade, agitação, sudorese, hipoxemia e hipercapnia. Antecedentes: sexo; idade; saturação de oxigênio inferior a 90%; doenças dos sistemas respiratório, cardiovascular, neurológico, gastrointestinal, neuromuscular e metabólico; infecções respiratórias; trauma; e venenos, toxinas e sedativos. Consequências: aumento da frequência cardíaca, diminuição da saturação parcial de oxigênio, aumento do uso dos músculos respiratórios, dispneia, aumento da taxa metabólica e inquietação. O caso-modelo e o caso oposto foram usados para ilustrar os atributos, os antecedentes e as consequências. Conclusões: o estudo teve como objetivo fortalecer as evidências sobre o fenômeno e demonstrou uma forte ocorrência em pacientes que necessitam de assistência em unidades de terapia intensiva e que, consequentemente, requerem cuidados críticos.

Simpatectomía torácica para hiperhidrosis focal: una revisión de alcance / Thoracic sympathectomy for focal hyperhidrosis: a Scoping Review

La hiperhidrosis focal primaria (HH) es un trastorno que consiste en sudoración que excede lo requerido para la termorregulación y afecta a 3 de cada 100 personas en la población general. Es considerada una enfermedad con alto impacto en la calidad de vida. La fisiopatología involucra el eje hipotálamo- sistema nervioso autónomo. A lo largo de la historia se han descrito múltiples terapias médicas y quirúrgicas con resultados variables. En la literatura se evidencia un vacío en el conocimiento acerca de la simpatectomía torácica (ST) y su utilidad en el contexto de HH. En miras a mejorar la calidad de vida de estos pacientes, realizamos una revisión cuidadosa de la literatura disponible actualmente, encontrando que la ST es un procedimiento seguro y efectivo, con altas tasas de éxito y satisfacción en estos pacientes.

Primary focal hyperhidrosis (HH) is a disorder consisting of sweating in excess of that required for thermoregulation and affects 3 out of 100 people in the general population. It is considered a disease with a high impact on quality of life. Pathophysiology involves the hypothalamic-autonomic nervous system axis. Throughout history, multiple medical and surgical therapies have been described with variable results. The literature shows a gap in knowledge about thoracic sympathectomy and its usefulness in the context of HH. To improve the quality of life of these patients, we carried out a careful review of the currently available literature, finding that ST is a safe and effective procedure, with high rates of success and satisfaction in these patients.

Personal Protective Equipment Associated Symptoms amongst Frontline Health Care Workers in COVID-19 Pandemic � A Cross Sectional Study

Context : During COVID-19 Pandemic, frontline Health Care Worker (HCW) in hospitals were mandated to Personal Protective Equipment (PPE), while caring for suspected or confirmed COVID-19 patients, which involved the donning of close-fitting N95 Face Masks, Protective Eyewear, Gowns, Surgical Gloves and the use of Powered AirPurifying Respirators (PAPR). Aims : This study is to know the challenges faced during use of PPE among frontline HCW. Methods and Material : This is a cross-sectional study among HCW at our Tertiary Institution who were working in high-risk hospital areas during COVID-19. All respondents completed a self-administered questionnaire Statistical analysis used : Data were entered in Microsoft Excel and analyzed using SPSS version 23. Baseline characteristics were described using frequency and percentages. Association between predictors of PPE associated symptoms were assessed using Chi-square test with p-value of <0.05 considered as significant. Results : Total of 190 Health Care Workers participated in the study. Doctors- contributed most [143/189 (75.2%)]. Majority of the respondents reported usage of Masks, Eyewear, Shield and Gown [126/189 (66.7%)], in which most of them donned N-95 mask [152/189(80.5%)], and Goggles [110/189 (58.2%)] average for 6.32 (2.40) hours a day and 18.15(8.65) days in a month. 83 respondents reported a new onset headache associated with usage of PPE. Majority of the respondents localized Headaches as frontal (69.9%) which was statistically significant. Other symptoms were Tiredness (73.5%), Excess Sweating (45.4%) and Giddiness (20.6%). Conclusions : Prevalence and characteristics of PPE- associated symptoms in HCW working in high-risk areas in Tertiary Care Centers necessitates better measures and strategies for designing PPE and reducing the exposure time in HCW and also the impact on their work performance

Advances in pharmacological effects of jujuboside B / 中国中药杂志

Ziziphi Spinosae Semen(ZSS) is an edible TCM derived from the dried ripe seeds of Ziziphus jujube Mill. var. spinosa(Bunge)Hu ex H. F. Chou(Rhamnaceae), which has the effects of nourishing the heart, tonifying the liver, calming the heart, tranquilizing the mind, arresting sweating, and promoting fluid production, and is widely used in the treatment and health care of diseases related to cardiovascular, nervous, and immune systems. Jujuboside B(JuB), one of the main active ingredients of ZSS, possesses various pharmacological effects with application values. This paper reviewed the chemical structure and pharmacological effects of JuB. JuB has sedative, hypnotic, antitumor, anti-platelet, anti-inflammatory, and other biological activities, which shows the potential thera-peutic effects on insomnia, tumors, coronary artery disease, airway inflammation, and liver injury. However, there are some limitations to the results of current studies. More comprehensive studies, including basic research and clinical trials, need to be carried out to provide more reliable evidence.

TONG Xiaolin's Cold-Damp Epidemic Differentiation and Treatment Concepts and Diagnostic and Therapeutic Key Points / 中医杂志

Building on a clear understanding of the diagnosis and treatment patterns for cold-damp epidemics， and incorporating the insights of Academician TONG Xiaolin regarding the differentiation and treatment of such epidemics， this article have distilled the key diagnostic principles. These principles primarily entail observing color and pulse， initially distinguishing between yin and yang， with treatment focusing on dispelling cold and dampness. A comprehensive approach is adopted throughout treatment， with a combination of overall strategies and tailored treatments that evolve in line with the patient's condition. In critical and severe cases， particular attention is given to aspects such as sweating， pulse analysis， and consciousness， preventing the pathogen from penetrating deeply. Efforts are made to open and close organ networks， expelling external pathogens without fixating on resolving constipation. The dosage and efficacy of herbal remedies are adjusted based on individual circumstances and clinical symptoms. The objective is to eliminate pathogens comprehensively， while being vigilant against relapses， ultimately achieving a full recovery. This overview of the thought processes and clinical principles for diagnosing and treating cold-damp epidemics will guide precise clinical practices and provide a theoretical foundation for the involvement of traditional Chinese medicine in epidemic prevention and treatment.

Application of prone position in severe ARDS caused by pneumocystis jirovecii pneumonia after kidney transplantation / 器官移植

Objective To investigate the improvement of oxygenation after the treatment of prone position in patients with severe acute respiratory distress syndrome (ARDS) caused by pneumocystis jirovecii pneumonia (PJP) after kidney transplantation. Methods Clinical data of 5 cases of moderate and severe ARDS caused by PJP after kidney transplantation were analyzed retrospectively, and clinical characteristics, treatment regimen and prognosis were summarized. Results Clinical manifestations of 5 patients were fever, dry cough, chest tightness, shortness ofbreath,sweating and fatigue, and body temperature fluctuated between 38 ℃ and 39 ℃, percutaneous arterial oxygen saturation(SpO2) was gradually decreased, and respiratory distress symptoms were worsened. Pulmonary CT scan showed diffuse ground-glass shadow. After transfer to intensive care unit (ICU), immunosuppressive drugs were terminated, and all patients were given with compound sulfamethoxazole, caspofungin, low-dose glucocorticoids against pneumocystis jirovecii (PJ), oxygen therapy and other symptomatic supportive treatments. Four patients diagnosed with severe ARDS upon admission to ICU were treated in a prone position. One patient with moderate ARDS was not kept in a prone position. At 1 d after treatment in a prone position, partial pressure of arterial oxygen (PaO2) and oxygenation index were increased, whereas alveolar-arterial oxygen difference (A-aDO2) was decreased compared with before treatment (allP<0.05). Compared with 1 d after treatment, SpO2, PaO2 and oxygenation index were all increased, while A-aDO2 was decreased at 4 d after treatment (all P<0.05). Box diagram showed that oxygenation index showed an overall upward trend after prone-position treatment, whereas A-aDO2 showed an overall downward trend. The length of ICU stay of 5 patients was 14 (8, 29) d. All patients in a prone position did not develop complications, such as skin pressure sore, tube detachment and tube displacement, etc. Among 5 patients, 4 patients were mitigated, and 1 patient died of septic shock and multiple organ failure. Conclusions For both conscious and intubated patients, a prone position may significantly improve oxygenation and prognosis of patients with severe ARDS caused by PJP after kidney transplantation. Early diagnosis and accurate and standardized treatment play a pivotal role in enhancing cure rate.

Treatment of Menopausal Syndrome Based on Phlegm，Stagnation，and Fire / 中医杂志

Menopausal syndromes are mostly based on kidney deficiency， which could be expalined that kidney governing essence storage and controlling innateness， so when the kidney water was deficient and the liver fail to nourish， then led to liver depression and transform into fire； deficiency of the kidney， loss of warmth of the spleen， and inability to transport and transform the water and dampness will easily lead to phlegm and fire； the decline of the kidney yin and loss of water and fire will easily cause the exuberance of heart fire. Therefore， clinical symptoms of hot flashes， insomnia， and palpitations are common due to phlegm， depressions， and fire. Based on this， at the beginning of the treatment， we should treat the symptoms firstly by resolving phlegm， relieving depression and clearing fire， and commonly use Huanglian Wendan Decoction （黄连温胆汤）， Yigan Powder （抑肝散）， Chaihu plus Longgu Muli Decoction （柴胡加龙骨牡蛎汤）， and Qingxin Zishen Decoction （清心滋肾饮）， etc. After improving the symptoms of hot flashes and sweating， irritability， dreaming and frightening， then we should give the prescriptions to tonify kidney yang and nourish kidney yin， in order to eliminate the pathogens and reinforce healthy qi， and to treat both the manifestations and the root cause， so that the symptoms of the patients can be better alleviated.

Clinical efficacy of botulinum toxin A in the treatment of hand hyperhidrosis / 中华医学美学美容杂志

Objective:To investigate the clinical efficacy of botulinum toxin A in the treatment of hand hyperhidrosis.Methods:One hundred patients with hand hyperhidrosis were treated with botulinum toxin A (BTXA, Lanzhou Biotechnology Development Co., Ltd., Botulinum Toxin Type A for Injection Hengli) injection, a total of 200 U. Each hand was injected with 100 U respectively. The curative effect was evaluated by self-made questionnaire. The scores of the two were added. The subjective and objective evaluation were carried out before and after injection, and the patients were rechecked 2 weeks, and 1, 4 and 6 months after injection. Efficacy, patient satisfaction and adverse reactions were evaluated.Results:Compared with before treatment, the effective rate increased 2 weeks after injection, 1 month after injection, 4 months after injection and 6 months after injection, and the difference was statistically significant (Chi-square value was 31.54, 36.33, 28.34, 25.23, respectively, P<0.05). After 6 months of follow-up, the effect gradually decreased, and the curative effect could be maintained for about 10 months. After recurrence, the symptoms of hand sweating were still reduced. Satisfaction 96%; Adverse reactions were mild, subcutaneous blood stasis, 27% hand muscles were slightly weak, and returned to normal after 2-3 weeks. Conclusions:Botulinum toxin A injection has certain curative effect, high safety and less adverse reactions. It is an ideal method for the treatment of hand hyperhidrosis.

A case report of late-onset MELAS with paroxysmal sympathetic hyperactivity syndrome / 中华神经科杂志

Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by paroxysmal tachycardia, increased blood pressure, tachypnea, hyperthermia, profuse sweating, abnormal posture or dystonia. It occurs in diseases such as moderate to severe brain injury, cerebral hypoxia, hydrocephalus, brain tumor and encephalitis. At present, the etiology and pathogenesis are still unclear, and it is easy to be misdiagnosed as epilepsy clinically. This article reports a 43-year-old male patient with late-onset mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) confirmed by genetic testing. During hospitalization, he suddenly developed episodic involuntary limb movements, profuse sweating, tachycardia, and arterial hypertension. He was initially diagnosed with symptomatic epilepsy, but long-term electroencephalogram monitoring showed no synchronized discharge, and he was given antiepileptic drugs. The treatment was also ineffective. Brain magnetic resonance imaging revealed a new lesion in the left insular and insular operculum. Dexmedetomidine, baclofen, and gabapentin were given to suppress sympathetic nerve excitability. Drugs were effective, so the diagnosis was corrected to PSH. There is no report of MELAS complicated with PSH in the previous literature. It is speculated that it may be related to the low clinical cognition of PSH. In this case, new lesions in the insula and insular operculum appeared during the onset of PSH, suggesting that may be related to the pathogenesis of PSH.

Prevalence survey of clinical manifestations following COVID-19 / 中华麻醉学杂志

Objective:To investigate the clinical manifestations of population following COVID-19 by using questionnaires.Methods:COVID-19 among anesthesia workers and the surrounding population was investigated between 11 November 2022 and 31 December 2022 in China.The Tencent electronic questionnaire(ID.11492813) was sent to different WeChat groups of the Association of Anesthesiologists or Society of Anesthesiologists via the WeChat platform of the medical personnel in China. The survey was conducted between January 7 and January 15, 2023. Results:A total of 17 000 questionnaires were issued for this survey, 11 060 valid questionnaires from 31 provinces and autonomous regions were collected all over the country, with a recovery rate of 65.059%.There were 10068 (91.037%) participants diagnosed as having COVID-19, and among of them, 47.606% were male and 52.394% were female. The main post-COVID-19 clinical manifestations included fever (85.777%), cough (83.731%), fatigue (75.338%), parasomnia (64.352%), limb soreness (58.890%), dizziness, headache, tinnitus (38.617%), loss or abnormality of taste (37.763%), and loss or abnormality of smell (30.960%); peripheral neuralgia was usually found within 3 days after positive nucleic acid test or positive antigen test; there were 2 963 cases accompanied with sweating, and among of them, 47.25% were male and 52.75% were female, and 37.80% of these participants continued to sweat after the nucleic acid test or antigen test became negative. There were 1 151 cases with premature heart beats among the study population, and the symptoms aggravated following COVID-19 were found in 34.32% of these patients.Conclusions:In addition to the respiratory system, the central and peripheral nerves of patients are also affected following COVID-19, and the peripheral and central nerve disorders last until several days after negative nucleic acid test or antigen test, suggesting that anesthesiologists should pay more attention to monitoring of various nerve function and impact of surgery and anesthetic drugs on the stress response of the body in such patients.

Retrospective analysis of epidemiological characteristics, clinical features, and complications of 1 279 adult brucellosis patients in Hulunbuir City / 中华地方病学杂志

Objective:To analyze the clinical data of adult patients with brucellosis and provide scientific basis for treatment of brucellosis.Methods:The medical records of 1 279 adult brucellosis patients treated in the Brucellosis Department of Hulunbuir People's Hospital from January 2013 to December 2020 were selected. Epidemiological characteristics, clinical characteristics, laboratory examination, complications and curative effect were analyzed retrospectively.Results:Among the 1 279 cases of brucellosis, there were 797 males and 482 females, with an average age of (39 ± 15) years. There were 464 cases in acute stage, 815 cases in chronic stage, and 1 221 cases contacted with animal fur such as cattle, sheep and sheep skin. The main clinical manifestations were fatigue (974), fever (819), hyperhidrosis (674) and joint and muscle pain (752). Spleen enlargement was the most common sign, with 151 cases in sequence. There were 623 complications in 1 279 patients with brucellosis. Bone and joint damage, blood system damage and liver damage were more common, with 563, 298 and 264 cases, respectively. Some patients even had multiple system damage. The titer range of in vitro agglutination test (SAT) in 1 279 patients with brucellosis was 1 ∶ 50++ to 1 ∶ 1 600++; 198 cases were positive for Brucella in blood culture; SAT was positive in 8 cases of cerebrospinal fluid and 4 cases of pleural effusion. There were 114 cases of leucopenia, 51 cases of leucopenia, 158 cases of thrombocytopenia, 93 cases of decreased hemoglobin, 205 cases of elevated alanine aminotransferase, 198 cases of elevated aspartate aminotransferase and 143 cases of elevated creatinine in 1 279 patients with brucellosis. Erythrocyte sedimentation rate increased in 587 cases and C-reactive protein increased in 563 cases. After treatment with two or three antibiotics for at least 12 weeks, the total effective rate was 98.3% (1 257/1 279). Conclusions:The clinical manifestations of brucellosis are varied. Clinicians should highly suspect brucellosis if the patient has a history of epidemiological exposure to brucellosis and has symptoms such as fever, sweating, joint muscle pain and fatigue. Early diagnosis and standardized treatment should be carried out to prevent the disease from becoming chronic and affecting the quality of life. The occupational population should strengthen physical examination and education for brucellosis.

Clinical characteristics of asymptomatic infection of brucellosis / 中华地方病学杂志

Objective:To analyze the clinical characteristics of asymptomatic infection of brucellosis, in order to provide reference for prevention and treatment of brucellosis.Methods:Retrospective analysis was used to collect the clinical data of patients with brucellosis asymptomatic infection and confirmed cases admitted to the 940th Hospital of Joint Logistics Support Force of Chinese PLA from 2017 to 2021, and the demography characteristics, clinical manifestations and laboratory test results were analyzed.Results:The results showed that a total of 18 cases of asymptomatic infection and 85 confirmed cases of brucellosis were included, and there was no statistically significant difference in age, gender, occupation and ethnicity distribution between the two groups ( F = 7.09, χ 2 = 0.74, 4.02, 0.55, P = 0.295, 0.785, 0.327, 1.000). The 18 cases of asymptomatic infection of brucellosis were found through screening in key populations, and no clinical symptoms or abnormal imaging signs were observed. The clinical symptoms of 85 confirmed cases were mainly muscle and joint pain, fever, sweating, fatigue, and low back pain; and the imaging manifestations were mainly arthritis, splenomegaly, and spondylitis. The median percentage of eosinophils (0.70%, 1.40%), percentage of basophils (3.05%, 0.40%), C-reactive protein (1.62, 4.62 mg/L), erythrocyte sedimentation rate (1.00, 11.00 mm/h), and antibody titer of serum agglutination test (1 ∶ 100, 1 ∶ 200) showed statistically significant differences between asymptomatic infection and confirmed cases of brucellosis ( Z = - 2.97, - 5.11, - 3.49, - 3.21, - 3.50, P = 0.003, 0.001, 0.001, 0.001, 0.007). Conclusions:There is a difference in the composition of granulocytes between asymptomatic infection and confirmed cases of brucellosis, and the level of inflammatory response indicators is lower than that of confirmed cases. Regular seroepidemiological surveys among key populations can help screen for asymptomatic infection of brucellosis.

Connotation of Xiao Chaihu Decoction combined with Maxing Shigan Decoction based on severe cases and modern pathophysiological mechanism and application for severe pulmonary infection and acute exacerbation of chronic obstructive pulmonary disease in critical care medicine / 中国中药杂志

Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic herbal formula. All of them are derived from Treatise on Cold Damage(Shang Han Lun) by ZHANG Zhong-jing. This combination has the effects of harmonizing lesser yang, relieving exterior syndrome, clearing lung heat, and relieving panting. It is mainly used for treating the disease involving the triple-Yang combination of diseases and accumulation of pathogenic heat in the lung. Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic combination for the treatment of exogenous diseases involving the triple-Yang combination. They are commonly used in exogenous diseases, especially in the north of China. This combination is also the main treatment strategy for coronavirus disease 2019(COVID-19) accompanied by fever and cough. Maxing Shigan Decoction is a classical herbal formula for treating the syndrome of phlegm-heat obstructing the lung. "Dyspnea after sweating" suggests the accumulation of pathogenic heat in the lung. Patients with mild symptoms may develop cough and asthma along with forehead sweating, and those in critical severe may develop whole-body sweating, especially the front chest. Modern medicine believes that the above situation is related to lung infection. "Mild fever" refers to syndromes rather than pathogenesis. It does not mean that the heat syndrome is not heavy, instead, it suggests that severe heat and inflammation have occurred. The indications of Xiao Chaihu Decoction combined with Maxing Shigan Decoction are as follows.(1) In terms of diseases, it is suitable for the treatment of viral pneumonia, bronchopneumonia, lobar pneumonia, mycoplasma pneumonia, COVID-19 infection, measles with pneumonia, severe acute respiratory syndrome(SARS), avian influenza, H1N1 influenza, chronic obstructive pulmonary disease with acute exacerbation, pertussis, and other influenza and pneumonia.(2) In terms of syndromes, it can be used for the syndromes of bitter mouth, dry pharynx, vertigo, loss of appetite, vexation, vomiting, and fullness and discomfort in the chest and hypochondrium. It can also be used to treat alternate attacks of chill and fever and different degrees of fever, as well as chest tightness, cough, asthma, expectoration, dry mouth, wanting cold drinks, feeling agitated, sweating, yellow urine, dry stool, red tongue, yellow or white fur, and floating, smooth, and powerful pulse, especially the right wrist pulse.

Zhenwu Decoction:connotation interpretation based on severe cases and modern pathophysiological mechanisms and application in treatment of heart failure in critical care unit / 中国中药杂志

Zhenwu Decoction is recorded in Treatise on Febrile Diseases by an outstanding physician ZHANG Zhong-jing in the Han dynasty. With effect of warming yang, transforming Qi, and promoting urination, Zhenwu Decoction is mainly used to treat edema due to yang deficiency. The studies of the severe and critical cases and the pathophysiological mechanisms have demonstrated that the record of Zhenwu Decoction in Treatise on Febrile Diseases describes the clinical symptoms and therapeutic regimen of acute heart failure. The syndrome treated by this formula may be related to the misdiagnosis and wrong treatment. Due to the difficult distinguishing between cardiogenic dyspnea and pulmonary dyspnea, high doses of Ephedrae Herba may be misused for inducing sweating, which may finally lead to the acute aggravation of heart failure, electrolyte disorder, and pulmonary infection. The syndrome treated by Zhenwu Decoction can illustrate the lack of experience of ancient physicians in treating acute heart failure. The description of "trembling and shivering" may be the clinical manifestation of heart failure, which is an upgraded version of "trembling and shaking" treated by Linggui Zhugan Decoction.(1)In terms of diseases, Zhenwu Decoction is suitable for the treatment of acute or chronic heart failure, cardiorenal syndrome, and diuretic resistance. The decoction is especially suitable for treating whole heart failure, acute heart failure, heart failure with reduced ejection fraction, and heart failure with the syndrome of sold and dampness. In addition, it can be used to treat both type Ⅱ and type Ⅳ cardiorenal syndrome.(2)In terms of symptoms, Zhenwu Decoction can be used for treating chest tightness, palpitations, lower limb edema, difficult urination or increased urine output, fear of cold, pale fat tongue with teeth marks, white and slippery tongue fur, and deep or slow pulse.(3)In terms of the pharmacological mechanism, Zhenwu Decoction treats heart failure following the principle of promoting urination, expanding blood vessels, and invigorating heart in modern medicine. Aconiti Lateralis Radix Praparata is the sovereign herb in the formula, with the recommended dosage of 30-60 g. However, arrhythmia may be caused by high doses of Aconiti Lateralis Radix Praparata, which should be used with concern. In addition to Zhenwu Decoction, Shenqi Pills, Renshen Decoction, Wuling Powder, and Fangji Huangqi Decoction with the effect of invigorating spleen, replenishing Qi, warming Yang, and promoting urination can be used in the recovery stage. The therapy of reinforcing Yang was the last choice for critical cases due to the lack of medical conditions, unclear clinical diagnosis in history, which should be treated objectively now.

Connotation of distal bleeding based on modern pathophysiological mechanism and application of Huangtu Decoction for acute coronary syndrome complicated with acute upper gastrointestinal hemorrhage in critical care medicine / 中国中药杂志

Huangtu Decoction, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, is used to treat distal bleeding. It is mainly treated for the syndrome of failing to control blood with spleen-yang deficiency. The connotation of distal bleeding is more extensive, including not only upper gastrointestinal bleeding in the traditional sense such as peptic ulcer bleeding, gastrointestinal tumors, gastric mucosal lesions, vascular dysplasia, esophagogastric variceal bleeding, and pancreatic and biliary tract injury, but also other anorectal diseases such as part colon and rectal cancer swelling or polyps, hemorrhoids, and anal fissure and other parts of bleeding such as epistaxis, thrombocytopenia, functional uterine bleeding, threatened abortion, and unexplained hematuria. Distal bleeding also involves syndromes of failing to keep part deficient and cold fluids in interior, such as nocturia, enuresis, clear nose, sweating, cold tears, and leucorrhea, and excessive gastrointestinal bleeding caused by anti-plate and anticoagulant drugs, unexplained positive in the fecal occult blood test, and other modern clinical new problems. The indications of Huangtu Decoction include not only lower blood, defecation before blood, distant blood, hematemesis, epistaxis, and other diseases in traditional Chinese medicine, but also three types of clinical manifestations including bleeding, deficiency syndrome, and stagnant heat syndrome. In the clinic, Huangtu Decoction can be used to treat acute upper gastrointestinal bleeding, acute coronary syndrome complicated with acute upper gastrointestinal bleeding, bleeding events caused by excessive antiplatelet and anticoagulant drugs, unexplained positive in the fecal occult blood test, gastrointestinal tumor with bleeding, thrombocytopenia, and other acute and critical diseases. The dosage of Cooking Stove Earthkey, Rehmanniae Radix, and Asini Corii Colla in Huangtu Decoction is the key to hemostasis.

Preliminary study of familial nonsyndromic tooth agenesis caused by ectodysplasin A mutation / 口腔疾病防治

Objective@# To explore the pathogenic genes in a Chinese family affected by nonsyndromic tooth agenesis so as to study the pathogenesis of oligodontia.@*Methods @# Hospital ethical approval and informed consent of the patients and family members were obtained. Clinical data of the proband and close family members were collected, peripheral venous blood was collected, and DNA was extracted. Gene sequencing was performed through whole-exome sequencing, and then the screened pathogenic genes were verified by Sanger sequencing. The three-dimensional structure of the mutant proteins was analyzed and compared with the wild-type using bioinformatics tools.@*Results@#The two patients with congenital majority tooth loss in this family were cousins, and there were no other patients with congenital majority tooth loss in the family. Besides congenital multiple tooth loss, the two patients had no obvious hair abnormalities, finger/toe abnormalities, sweating abnormalities or other abnormal manifestations of ectodermal tissue. We found a mutant gene that in this family by carrying out gene sequencing of the patients and their close family members. A novel EDA (ectodysplasin A) missense mutation c.983C>T (p. Pro328Leu) was identified, which changed the encoded amino acid from proline (Pro) to leucine (Leu). Analysis of the mutation site showed that the site was highly conserved, and three-dimensional structure modeling also found that it changed the structure of EDA. @* Conclusion@#A novel EDA missense variant (c.983C>T, p.Pro328Leu) was first identified in a Chinese family with nonsyndromic tooth agenesis, extending the mutation spectrum of the EDA gene.

Anti-HMGCR immune-mediated necrotizing myopathy: A case report / 北京大学学报(医学版)

The patient was a 55-year-old man who was admitted to hospital with "progressive myalgia and weakness for 4 months, and exacerbated for 1 month". Four months ago, he presented with persistent shoulder girdle myalgia and elevated creatine kinase (CK) at routine physical examination, which fluctuated from 1 271 to 2 963 U/L after discontinuation of statin treatment. Progressive myalgia and weakness worsened seriously to breath-holding and profuse sweating 1 month ago. The patient was post-operative for renal cancer, had previous diabetes mellitus and coronary artery disease medical history, had a stent implanted by percutaneous coronary intervention and was on long-term medication with aspirin, atorvastatin and metoprolol. Neurological examination showed pressure pain in the scapularis and pelvic girdle muscles, and V- grade muscle strength in the proximal extremities. Strongly positive of anti-HMGCR antibody was detected. Muscle magnetic resonance imaging (MRI) T2-weighted image and short time inversion recovery sequences (STIR) showed high signals in the right vastus lateralis and semimembranosus muscles. There was a small amount of myofibrillar degeneration and necrosis, CD4 positive inflammatory cells around the vessels and among myofibrils, MHC-Ⅰ infiltration, and multifocal lamellar deposition of C5b9 in non-necrotic myofibrils of the right quadriceps muscle pathological manifestation. According to the clinical manifestation, imageological change, increased CK, blood specific anti-HMGCR antibody and biopsy pathological immune-mediated evidence, the diagnosis of anti-HMGCR immune-mediated necrotizing myopathy was unequivocal. Methylprednisolone was administrated as 48 mg daily orally, and was reduced to medication discontinuation gradually. The patient's complaint of myalgia and breathlessness completely disappeared after 2 weeks, the weakness relief with no residual clinical symptoms 2 months later. Follow-up to date, there was no myalgia or weakness with slightly increasing CK rechecked. The case was a classical anti-HMGCR-IMNM without swallowing difficulties, joint symptoms, rash, lung symptoms, gastrointestinal symptoms, heart failure and Raynaud's phenomenon. The other clinical characters of the disease included CK as mean levels >10 times of upper limit of normal, active myogenic damage in electromyography, predominant edema and steatosis of gluteus and external rotator groups in T2WI and/or STIR at advanced disease phase except axial muscles. The symptoms may occasionally improve with discontinuation of statins, but glucocorticoids are usually required, and other treatments include a variety of immunosuppressive therapies such as methotrexate, rituximab and intravenous gammaglobulin.