Cold and Heat in Acute Coronary Syndrome： A Review / 中国实验方剂学杂志

Cold and heat belong to the eight-principal syndrome differentiation of traditional Chinese medicine， which can reflect the rise and fall of Yin and Yang in the body and the Yin and Yang nature of the disease. At present， traditional Chinese medicine has an inconsistent understanding of cold and heat in acute coronary syndrome. The emphasis on pathogenic factors of cold and heat is biased， and the elements of cold and heat syndrome are not fully reflected in the scale. Therefore， the literature has been reviewed from the perspectives of etiology， pathogenesis， symptom elements， and test signs with drugs. From the perspective of etiology， both cold evil and heat evil can increase the risk of acute coronary syndrome. It was previously believed that acute coronary syndrome occurs frequently in cold climates such as winter and spring. Based on this understanding， hot weather can also induce acute coronary syndrome， and different temperatures have different effects on patients of different ages and with different underlying diseases. In addition， artificial pathogenic factors such as excessive consumption of cold food and refrigeration air conditioners were added. From the perspective of pathogenesis， on the basis of the traditional ''asthenia in origin and asthenia in superficiality'' and ''phlegm stagnation''， it is found that Yin-cold and fire-heat can both cause paralysis of the heart chakra and pain induced by the blockage. The pathogenesis of acute coronary syndrome characterized by heat stagnation and coldness featuring heartburn should be distinguished from gastroesophageal reflux disease. Moreover， the pathogenesis of Yin cold coagulation and pulse stagnation and wind obstruction are different. The acute coronary syndrome is in line with the wind characteristics of frequent changes and can be treated with wind medicine. From the perspective of syndrome elements， the syndrome elements such as cold condensation， heat accumulation， and toxicity are analyzed， and the use of basic syndrome elements and their combination forms facilitates clinical and scientific research. In addition， according to the test sign with the drug， it can be seen that the attributes of cold and heat of traditional Chinese medicine prescriptions for acute coronary syndrome can be explained according to the temperature-sensitive transient receptor potential （TRP） ion channel， thus proving the pathogenesis of cold and heat of acute coronary syndrome.

Evolution and innovation of preservation fluid for donor liver / 器官移植

Organ preservation fluid could mitigate cold ischemia injury and maintain normal function of the grafts. At present, how to reduce a series of injury caused by cold ischemia of donor liver and improve the preservation quality of grafts are the hot and challenging spots in this field. Currently, preservation fluid in clinical practice has not achieved ideal preservation effect, especially for the protection of marginal donor organs. In the context of severe donor shortage, the key solution is still to explore the optimal preservation protocol for donor liver to prevent grafts from cold ischemia injury. In this article, the mechanism of donor liver injury during cold ischemia, the classification and evolution of donor liver preservation fluid were summarized, the development direction and challenges of donor liver preservation fluid were discussed, aiming to provide novel ideas and references for the research and development of donor liver preservation fluid.

Clinical Efficacy of Modified Banxia Xiexintang Combined with Vedolizumab in Treatment of Crohn's Disease with Syndrome of Cold and Heat in Complexity / 中国实验方剂学杂志

ObjectiveTo evaluate the clinical efficacy of modified Banxia Xiexintang combined with vedolizumab （VDZ） in the treatment of active moderate to severe Crohn's disease （CD） with the syndrome of cold and heat in complexity and the effect of the therapy on intestinal flora. MethodEighty patients were randomized based on the random number table method into a control group （40 cases） and an observation group （40 cases）. The control group was treated with VDZ， and the observation group was treated with modified Banxia Xiexintang （1 bag per day） combined with VDZ. The treatment in both groups lasted for 14 weeks and the follow-up lasted until the 52th weeks. The CD activity index （CDAI）， CD simplified endoscopic score （SES-CD）， inflammatory bowel disease questionnaire （IBDQ） score， and syndrome score of cold and heat in complexity were assessed before treatment， after treatment， and at the end of follow-up. The levels of hemoglobin （HGB）， hematocrit （HCT）， albumin （ALB）， C-reactive protein （CRP）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， interleukin-17 （IL-17）， and fecal calprotectin （FC） were measured before and after treatment. Intestinal flora was examined before and after treatment. The safety of the therapy was evaluated. ResultCompared with those before treatment， the scores of CDAI， SES-CD， and the syndrome of cold and heat in complexity decreased （P<0.05） and the IBDQ score increased after treatment （P<0.05）. Compared with those before treatment， the scores of CDAI， SES-CD， and the syndrome of cold and heat in complexity increased （P<0.05） and the IBDQ score decreased （P<0.05） at the end of follow-up. After treatment and at the end of follow-up， the observation group had lower scores of CDAI， SES-CD， and syndrome of cold and heat （P<0.05） and higher IBDQ score （P<0.05） than the control group. Moreover， the observation group had higher clinical remission rate（χ2=4.381，3.962） and response rate（χ2=5.541，4.306） and lower non-response rate（χ2=6.646，4.306） than the control group at the two time points （P<0.05）. The endoscopic remission rate（χ2=4.072，3.985） and response rate（χ2=4.528，5.161） in the observation group were higher than those in the control group （P<0.05）. After treatment， the HGB， HCT， and ALB levels in both groups elevated， and the observation group had higher levels than the control group （P<0.05）. The treatment in both groups lowered the levels of CRP， IL-6， TNF-α， IL-17， and FC （P<0.05）， and the observation group had lower levels of CRP， IL-6， TNF-α， IL-17， and FC than the control group after treatment （P<0.05）. The relative abundance of Bifidobacterium， Lactobacillus， and Prevotella increased （P<0.05）， while that of Proteus， Klebsiella， and Enterococcus decreased （P<0.05） in the two groups after treatment. Moreover， the changes in the relative abundance of these bacteria in the observation group were more obvious than those in the control group （P<0.05）. No adverse reactions related to the modified Modified Banxia Xiexintang were observed during the study period. ConclusionModified Banxia Xiexintang combined with VDZ can play a synergistic role and has good short-term and long-term efficacy. This therapy can improve the nutritional status， regulate intestinal flora， and reduce inflammatory injury in the treatment of moderate to severe active CD patients with the syndrome of cold and heat in complexity without causing severe adverse reactions.

Polipectomia a frio: um procedimento seguro para remover pequenas lesões colorretais não pediculadas / Cold snare polypectomy: a safe procedure for removing small non-pedunculated colorectal lesions

ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re­cognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. Results: A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

RESUMO Contexto: A polipectomia é uma importante opção terapêutica na prevenção do câncer colorretal (CCR). A ressecção incompleta do pólipo (RIP) é reconhecida como fator de risco para o câncer de intervalo. Objetivo: O principal objetivo foi avaliar o índice de ressecção completa da polipectomia a frio (PF) em pequenos pólipos não pediculados e, secundariamente, a recuperação do espécime e índice de complicações. Métodos: Avaliamos prospectivamente 479 pólipos <10 mm removidos por PF em 276 pacientes, por um endoscopista sem experiência com este método. Resultados: Foram ressecados em bloco 476 pólipos (99,4%). Tivemos margem negativa, considerada ressecção completa do pólipo (RCP), em 435 (90,8%) casos. Margem indefinida ou positiva (classificada como RIP) foi observada em 43 (9,0%) casos e em 1 (0,2%) caso, respectivamente, com um índice global de RIP de 9,2% (44/479). O índice de RIP foi de 12,5% na primeira metade dos casos e 5,9% na última metade (P=0,02). Dividindo em tercis, o índice de RIP foi de 15,0% no primeiro terço, 6,9% no segundo terço e 5,7% no terceiro quarto, P=0,01. Dividindo em quartis, o índice de RIP foi de 15,8% no primeiro quarto, enquanto o último quarto foi de 5,9%, P=0,03. O índice de RIP foi de 6,3% para lesões tipo 0-IIa e de 14,1% para lesões tipo 0-Is, P=0,01. O índice de RIP foi de 9,2% para lesões serrilhadas e adenomatosas. Houve falha na recuperação dos espécimes em 3,6% dos casos. Sangramento imediato (>30 s) ocorreu em um caso (0,2%), controlado com plasma de argônio. Sem sangramento tardio e perfuração. Conclusão: PF é uma técnica segura que apresenta bons resultados para a ressecção de pequenas lesões não pediculadas, com uma curta curva aprendizado.

Conservation of Organs (Heart, Brain and Kidney) of Canine by Cold-Temperature Silicone Plastination in an Animal Anatomy Laboratory in Ecuador / Conservación de Órganos (Corazón, Encéfalo y Riñón) de Canino Mediante la Técnica de Plastinación en Silicona al Frío Realizada en Laboratorio de Anatomía Animal en Ecuador

SUMMARY: For the purposes of teaching anatomy, the use of cadaver preparations is considered the most efficient way of ensuring that students retain knowledge. Nevertheless, in Ecuador the use of animal specimens in universities must comply with the internationally accepted principles of replacement, reduction and refinement (3Rs). Plastination is an alternative technique which allows organs to be conserved in the long term and complies with the 3Rs. The object of the present work was to use cold-temperature silicone plastination with Biodur® products to obtain long-lasting, easy-to-handle canine organs for use as tools for the teaching of animal anatomy. Six canine cadavers were obtained from local animal protection charities. The hearts, brains and kidneys of the cadavers were dissected and fixed with formaldehyde 10 %. They were then dehydrated with acetone at -20 °C. The specimens were impregnated with Biodur® S10:S3 (-20 °C) and finally cured with Biodur® S6. We plastinated six hearts, twelve kidneys, four brains and one encephalic slice of canine. The application of cold-temperature plastination to canine organs followed the parameters established for the conventional protocol, enabling us to obtain organs of brilliant appearance, free of odours, in which the anatomical form was preserved. Thus the technique helped us to comply with the 3Rs, as we obtained easy-to-handle teaching models to replace fresh or formaldehyde-fixed samples for the teaching-learning of the canine anatomy.

En la enseñanza de la Anatomía, el uso de preparaciones cadavéricas se considera el método que permite a los estudiantes retener el conocimiento de una forma más eficiente. No obstante, en Ecuador, el uso de especímenes animales en las universidades se debe realizar bajo el principio internacional de reemplazo, reducción y refinamiento (3Rs). La técnica de plastinación es una técnica alternativa que permite preservar órganos a largo plazo y que se adapta al principio de las 3Rs. El objetivo del trabajo fue utilizar la técnica de plastinación en silicona al frío con productos Biodur® para obtener órganos caninos duraderos y manejables útiles como herramienta para la enseñanza de la anatomía animal. Se obtuvieron seis cadáveres de caninos de fundaciones locales para la protección animal. Se realizaron disecciones de corazones, cerebros y riñones de los cadáveres caninos. Los órganos se fijaron con formalina al 10 %. A continuación, se llevó a cabo la deshidratación con acetona a -20 °C. Los especímenes fueron impregnados con S10:S3 Biodur® (-20 °C) y al final fueron curados con Biodur® S6. Se lograron plastinar seis corazones, doce riñones, cinco encéfalos y un tallo encefálico de canino. La técnica de plastinación al frío utilizada para obtener órganos de canino conservó los parámetros empleados en el protocolo convencional y permitió obtener órganos que presentaron aspecto brillante, ausencia de olores y mantuvieron la forma anatómica. Por lo que, la técnica facilitó cumplir con el principio de las 3Rs al obtenerse modelos didácticos fáciles de manipular que pueden reemplazar muestras frescas o formolizadas en el proceso de enseñanza-aprendizaje de la anatomía del canino.

Cardiopulmonary Bypass Surgery?Cold Alert!

The term 揷old agglutinin (CA)� refers to a group of disorders caused by anti?erythrocyte autoantibodies that preferentially bind RBCs at cold temperatures (4癈�癈). CAs contribute to 10 to 15% of autoimmune hemolytic anemia. We report a case of CAs diagnosed intraoperatively during emergency mitral valve replacement.

Cold bandage contact lens use reduces post-photorefractive keratectomy or corneal collagen-crosslinking pain perception in patients

Purpose: To compare post?operative pain perception using bandage contact lens (BCL) stored at 2–8?C (Cold BCL, CL?BCL) or room temperature (23 – 25?C, RT?BCL) after photorefractive keratectomy (PRK) or corneal collagen?crosslinking (CXL) and determine status of nociception associated factors. Methods: In this prospective interventional study, 56 patients undergoing PRK for refractive correction and 100 keratoconus (KC) undergoing CXL were recruited following approval from the institutional ethics committee with informed consent. Patients undergoing bilateral PRK received RT?BCL on one eye and CL?BCL on the other. Pain was graded by Wong–Baker scoring on the first post?operative day (PoD1). Expression of transient receptor potential channels (TRPV1, TRPA1, TRPM8), calcitonin gene?related peptide (CGRP) and IL?6 was measured in cellular content from used BCLs collected on PoD1. Equal number of KC patients received RT?BCL or CL?BCL post?CXL. Pain was graded by Wong–Baker scoring on PoD1. Results: Pain scores on PoD1 were significantly (P < 0.0001) reduced in subjects receiving CL?BCL (Mean ± SD: 2.6 ± 2.1) compared to RT?BCL (6.0 ± 2.4) post?PRK. 80.4% of subjects reported reduced pain scores with CL?BCL. 19.6% reported no change or increased pain scores with CL?BCL. TRPM8 expression was significantly (P < 0.05) increased in BCL of subjects reporting reduced pain with CL?BCL compared to those who did not. Pain scores on PoD1 were significantly (P < 0.0001) reduced in subjects receiving CL?BCL (3.2 ± 2.1) compared to RT?BCL (7.2 ± 1.8) post?CXL. Conclusion: The simple approach of using a cold BCL post?operatively substantially reduced pain perception and could overcome post?operative pain?related limited acceptance of PRK/CXL.

A cross-sectional study of influence of cerebral dominance on cardiovascular responses to autonomic stressor tests in adolescents

Background: Hand preference is perhaps the most obvious behavioral asymmetry observed in humans and is related to cerebral dominance. Animal and human studies have shown that cerebral cortex has a definite role in regulation of cardiovascular autonomic activity. Each hemisphere exhibits differential control over dynamics of heart especially the sympathetic activity is controlled by right hemisphere insula in particular. Hence, the present study was conducted to evaluate influence of cerebral dominance (handedness) on cardiovascular responses such as heart rate (HR) and blood pressure (BP) indices to autonomic stressor tests in the left and right hander adolescents. Aims and Objectives: The aim of the study was to evaluate the differences in cardiovascular responses in the left and right handers to autonomic stressor tests. Materials and Methods: The present cross-sectional study was conducted in 35 right and 35 left hander students of age group 16–20 years. Autonomic stressor tests used in the study were handgrip dynamometry and cold pressor test (CPT). Results: The right and left handers had similar baseline values of BP and HR. All the subjects responded to Autonomic function tests by increased BP and HR from baseline. The absolute BP values and change in BP from baseline were significantly higher in the left than right handers both during and after the tests. HR values showed significant differences in peak values during both the tests. Visual analog score was similar during CPT in both groups. Conclusion: The HR and BP responses to autonomic stressor tests are higher in the left handers than right handers supports the fact that the right hemisphere has more influence on sympathetic activity of heart.

Cold antibody autoimmune hemolytic anemia following varicella infection

Introduction: Autoimmune hemolytic anemia (AIHA) is a rare complication of chicken pox. In adults, such AIHA is due to warm antibodies. We report a case of cold antibody AIHA following chicken pox in a young female. Case Report: A 24-year-old female presented with clinical and laboratory features consistent with hemolytic anemia 5 days after the onset of chicken pox. Her hemoglobin levels dropped rapidly during the course of admission from 7.9 to 3.8 g/dL with evidence of ongoing haemolysis in the form of rising total and indirect bilirubin. Peripheral smear revealed red cell agglutinates and erythrophagocytosis. Direct Coomb's test (DCT) was positive for C3d suggesting a cold antibody AIHA. Since test for Donath Landsteiner antibody was negative, and all other tests for common causes of hemolytic anemia were noncontributory, it was presumed to be due to chicken pox. The fulminant course necessitated a short course of oral steroids to which she responded with rise in hemoglobin and no further hemolysis. Two weeks later, her peripheral smear was normal and DCT negative. Conclusion: In patients presenting with acute onset anemia following chicken pox, possibility of cold antibody AIHA must be considered and appropriate testing pursued. Despite lack of empiric evidence, short course of steroids may be beneficial if drop in hemoglobin is rapid with evidence of fulminant hemolysis, showing no abatement after first week.

Effect of acute or subchronic stress on T cell response in peripheral blood: Regulatory role of vitamin D

The immune response, orchestrated by helper (Th1, Th2, and Th17) and regulatory (Treg) T cells, is modulated by stress and Vitamin D (Vit-D). Although the immunomodulatory functions of both are known, their specific roles on Th cells have not been fully clarified, yet. On this background, we aimed to investigate the effect of acute or subchronic stress on the distribution of peripheral T lymphocytes, as well as the immunomodulatory role of Vit-D. Young adult male, Swiss-albino mice (30–40g) were allocated to the control, acute stress (AS), subchronic stress (ChS), control+Vit-D, AS+Vit-D, and ChS+Vit-D groups (n=11/group). The combined cold (2-h at 4°C)-immobilization (2-h in a restrainer) stress protocol was employed as one day in AS groups and five consecutive days in ChS groups. Vit-D (2?g/kg ip) was applied every other day, until the end of the protocol. Serum cortisol, Vit-D and cytokine levels (IL-4, IFN-?, and IL-17A) were measured, and lymphocytes from blood samples were subtyped by flow-cytometry. Stress exposure caused differential Th and Treg responses, acute stress shifting the response to Th1, and subchronic stress shifting the response to Th2. Th17 and Treg cells were lower in subchronic stress exposed mice. These changes became comparable to control values in Vit-D treated groups. The T cell response, crucial for immune system function, differs on the basis of stress exposure as such the Vit-D treatment. The tolerogenic profile created by Vit-D should be considered for management of stress-related diseases. Our results may help to provide a better understanding of disease pathogenesis.

Apocalipse pop: representações do fim do mundo em canções brasileiras da década de 1980 / Pop apocalypse: representations of the end of the world in Brazilian songs from the 1980s

Resumo Esta pesquisa, com o uso da metodologia sócio-histórica, aborda a relação entre a produção cultural e as visões sobre a ciência e a tecnologia na década de 1980. Analisa um repertório de canções lançadas nesse período que apresentam temática apocalítica por conta do contexto de Guerra Fria e das crises ambientais. A análise se fundamenta nas noções de horizonte de expectativas de Koselleck e nas expectativas decrescentes de Arantes. As canções estão agrupadas na temática nuclear e na temática ambiental. Observa que essas canções da década de 1980 representam uma mudança da expectativa nacional com relação ao futuro, apresentando um temor acerca de desastres nucleares ou ambientais.

Abstract This study utilized socio-historical methodology to investigate the relationship between cultural production and views on science and technology in the 1980s by analyzing a repertoire of songs released during this period containing apocalyptic themes due to the context of the Cold War and environmental crises. This exploration is based on Koselleck's notions of the horizon of expectations and on Arantes' concept of decreasing expectations. The songs centered around nuclear power and the environment. We observed that these songs from the 1980s represent a shift in national expectations about the future, exhibiting fears related to nuclear and environmental disasters.

The low-temperature effect on sports regeneration / O efeito da baixa temperatura na regeneração esportiva

Abstract Introduction Intense physical activity and increased exercise significantly reduce the body's adaptive capacity, negatively affect the recovery processes of athletes, and can significantly impair athletic performance. Objective To identify how low temperatures can affect the regenerative processes in athletes, assess the effectiveness and feasibility of cold therapy in sports, and identify the key parameters that determine the effectiveness of the stated recovery method. Methods A systematic review of studies related to the use of cold therapy in sports guided by the Cochrane Handbook for Systematic Reviews of Interventions, and reported through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The scientific material was selected by finding keywords and phrases, including "the effect of cold on athletes", "athletes' recovery", "cold therapy", etc. Following the selection criteria, only 30 studies were included. Results Cold exposure has significant benefits for sports regeneration, including pain relief (100%), inflammation reduction (93%), and restoration of sprint capabilities (89%). However, its impact on muscle strength (33%), endurance (11%), and lactate reduction (8%) is more limited. It moderately improves the psycho-emotional state (65-75%). Conclusion The use of low temperatures in sports has a beneficial effect on the recovery of sports performance for at least 24 hours after intense physical activity (training).

Resumo Introdução A atividade física intensa e o aumento do exer-cício reduzem significativamente a capacidade de adaptação do organismo, afetam negativamente os processos de recu-peração dos atletas e podem prejudicar significativamente o desempenho atlético. Objetivo Identificar como as baixas temperaturas podem afetar os processos regenerativos dos atletas, avaliar a eficácia e a viabilidade da terapia pelo frio no esorte e identificar os parâmetros-chave que determinam a eficácia do método de recuperação indicado. Métodos Revisão sistemática de estudos relacionados com a utilização da terapia pelo frio no esporte, orientada pelo Manual Cochrane para Revisões Sistemáticas de Intervenções e reportada através dos Preferred Reporting Items for Systematic Reviews and Meta-Analyses. O material científico foi selecionado através da pesquisa de palavras-chave e frases, incluindo "o efeito do frio nos atletas", "recuperação dos atletas", "terapia pelo frio", etc. Seguindo os critérios de seleção, foram incluídos apenas 30 estudos. Resultados A exposição ao frio tem benefícios significativos para a regeneração esportiva, incluindo o alívio da dor (100%), redução da inflamação (93%) e restauração das capacidades de sprint (89%). No entanto, o seu impacto na força muscular (33%), na resistência (11%) e na redução do lactato (8%) é mais limitado. Há uma melhora moderada sobre o estado psico-emocional (65-75%). Conclusão A utilização de baixas temperaturas no esporte tem um efeito benéfico na recuperação do desempenho esportivo durante pelo menos 24 horas após uma atividade física intensa (treino).

Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation

Abstract Introduction Tonsillectomy is among the most common otolaryngological surgeries. Objective To evaluate and compare three tonsillectomy techniques: cold steel dissection (CSD), monopolar electrocautery (MEC), and coblation. Methods The present study retrospectively reviewed the medical records of patients who underwent tonsillectomy between January 2014 and January 2016. Postoperative visual analog scale (VAS) pain scores, analgesic use, surgical duration, time to return to normal activity, and postoperative bleeding status were noted. Results The CSD group had less analgesic use and shorter return to normal activity than the MEC group (p =0.037 and p < 0.001, respectively). The coblation group had lower VAS pain scores than the MEC group only at 1 hour to 4 hours postsurgery (p <0.016). The postoperative bleeding rate was similar in all groups (p = 0.096). Conclusion Cold steel dissection tonsillectomy is associated with less postoperative pain and shorter recovery than MEC. Coblation is better than MEC in terms of postoperative pain at 1 hour to 4 hours only, whereas CSD is associated with less postoperative pain than coblation at 2 days to 7 days.

A nationwide analysis of the outcomes in hospitalized patients with atrial fibrillation and temperature-related illnesses

Abstract Objectives The authors evaluated mortality and indices of cost of care among inpatients with Atrial Fibrillation (AF) and a diagnosis of a Temperature-Related Illness (TRI). The authors also assessed trends in the prevalence of TRIs among AF hospitalizations. Methods In this cross-sectional study, the authors used discharge data from the Nationwide Inpatient Sample (NIS) collected between January 2005 and September 2015 to identify patients with a diagnosis of AF and TRI. Outcomes of interest included in-hospital mortality, invasive mechanical ventilation, hospital length of stay, and cost of hospitalization. Results A total of 37,933 encounters were included. The median age was 79 years. Males were slightly overrepresented relative to females (54.2% vs. 45.8%, respectively). Although Blacks were only 6.6% of the cohort, they represented 12.2% of the TRI cases. Compared to non-TRI-related hospitalizations, a diagnosis of a TRI was associated with an increased likelihood of invasive mechanical ventilation (16.5% vs. 4.1%, p< 0.001), longer length-of-stay (5 vs. 4 days, p <0.001), higher cost of care (10,082 vs. 8,607, in US dollars p <0.001), and increased mortality (18.6% vs. 5.1%, p <0.001). Compared to non-TRI, cold-related illness portends higher odds of mortality 4.68, 95% Confidence Interval (4.35-5.04), p <0.001, and heat-related illness was associated with less odds of mortality, but this was not statistically significant 0.77 (0.57-1.03), p= 0.88. Conclusion The occurrence of TRI among hospitalized AF patients is small but there is an increasing trend in the prevalence, which more than doubled over the decade in this study. Individuals with AF who are admitted with a TRI face significantly poorer outcomes than those admitted without a TRI including higher mortality. Cold-related illness is associated with higher odds of mortality. Further research is required to elucidate the pathogenic mechanisms underlying these findings and identify strategies to prevent TRIs in AF patients.

Connotation， Key Scientific Issues， and System Building of Classical Herbal Formulae for Critical Care Medicine / 中国实验方剂学杂志

In contemporary clinical practice of traditional Chinese medicine （TCM）， there is a strong emphasis on treating chronic difficult diseases and preventing diseases before they occur （"pre-disease" treatment）. However， the treatment of critical care medicine has not received as much attention and is even facing a trend of diminishing influence in the field of emergency medicine and critical care. Critical care medicine refers to a class of diseases that are characterized by rapid onset， severity， quick progression， and high mortality rates in clinical practice. The growth and development of renowned TCM experts throughout history have invariably been honed through practical experiences in managing critical care medicine. Treatise on Cold Damage （《伤寒论》） is a dedicated work for treating critical care medicine， and the classic prescriptions in Treatise on Cold Damage are particularly central to the treatment of these diseases. In the current clinical context， it is important to break through the prevailing mindset that the strengths of TCM lie solely in treating chronic diseases and maintenance-type illnesses， identify the entry point of TCM in the clinical advantages in the field of critical care medicine， explore the interdisciplinary relationship between Treatise on Cold Damage and critical care medicine， enhance the ability to treat critical care medicine using classic prescriptions， establish a disciplinary system for prescription-based treatment of critical care medicine， reveal clinical evidence for prescription-based treatment of these diseases， and elevate the contribution of TCM in the domain of critical care medicine. These have become a strong call and demand in contemporary TCM clinical practice. Regarding key scientific issues， the system of using classic prescriptions to treat critical care medicine encompasses traditional core theories such as the nature of cold damage， the essence of the six meridians， the implications of specific clauses， and the dosages of classic prescriptions. In the context of future academic inheritance and system construction， it is recommended to focus on clinical challenges， break away from the current limitations of traditional classical disciplinary systems， such as their singular patterns and weak innovative and translational capabilities， suggest defining diseases in critical care medicine responding specifically to TCM， advocate a research model based on combining disease mechanisms with pathology and combining medicinal properties with pharmacology， establish a comprehensive multidisciplinary thinking mode， and encourage collaborative innovative research among medical， educational， research， and manufacturing institutions. This will help chart the path and address key aspects of constructing a comprehensive system for prescription-based treatment of critical care medicine.

Experience of Treating Hyperthyroidism in Lingnan Region with Modified Huanglian Decoction （黄连汤） / 中医杂志

The climate in the Lingnan area south China is characterized by high temperature and rainy days， and in terms of the eating habits， the local people are more addicted to raw， cold and savory food， all of which make Lingnan people prone to a constitution of upper heat and lower cold， and pathological manifestations of upper heat and lower cold. It is believed that the main pathogenesis of hyperthyroidism in Lingnan area is the upper heat and the lower cold， manifested as spleen yang deficiency and stomach fire excess， or kidney water depletion and heart fire hyperactivity， leading to upper heat and lower cold syndrome caused by disharmony of yin and yang and abnormal ascending and descending. Therefore， spleen cold and stomach heat and disharmony between the heart and the kidney are the main syndromes of hyperthyroidism in Lingnan area. Modified Huanglian Decoction （黄连汤） is commonly used. Additionally， for spleen cold and stomach heat syndrome， Fushen （Sclerotium Poriae Pararadicis） and Baizhu （Rhizoma Atractylodis Macrocephalae） can be added to supplement spleen and stomach， thereby treating both the root and the branch. In terms of the disharmony between the heart and the kidney syndrome， Muli （Concha Ostreae） is usually added to subdue yang and supplement yin， together with Wuweizi （Fructus Schisandrae Chinensis） to supplement kidney and calm heart and Shashen （Radix Adenophorae seu Glehniae） to nourish yin and engender liquid， thereby enriching kidney-water and moistening heart-yin. Modification of the formulas is suggested in accordance with the syndromes to achieve a better effect.

Sjögren's syndrome combined with cold agglutinin disease: A case report / 北京大学学报(医学版)

Sjögren's syndrome(SS)is a chronic autoimmune disease that affects exocrine glands, especially salivary and lacrimal glands. The main clinical manifestations are dry mouth and dry eyes, but also multi-organ and multi-system can be involved. Cold agglutinin disease(CAD)is an autoimmune disease characterized by red blood cell agglutination in the blood vessels of extremities caused by cold agglutinin at low temperature, resulting in skin microcirculation disturbance, or hemolytic anemia. Cold agglutinin disease is divided into two categories, primary cold agglutinin disease and secondary cold agglutinin disease. Primary cold agglutinin disease is characterized with cold agglutinin titer of 1 ∶4 000 or more and positive Coomb's test. However, the Coomb's test is not necessarily positive and the cold agglutinin titer is between 1 ∶32 and 1 ∶4 000 in secondary cold agglutinin disease. Here, we reported an elderly patient admitted to hospital due to fever. He was diagnosed with respiratory infection, but he showed incompletely response to the anti-infection treatment. Further laboratory tests showed the patient with positive ANA and anti-SSA antibodies. Additionally, the patient complained that he had dry mouth and dry eyes for 1 year. Schirmer test and salivate gland imaging finally confirmed the diagnosis Sjogren's syndrome. During the hospital stay, the blood clots were found in the anticoagulant tubes. Hemolytic anemia was considered as the patient had anemia with elevated reticulocytes and indirect bilirubin. In addition, further examination showed positive cold agglutination test with a titer of 1 ∶1 024, and cold agglutinin disease was an important type of cold-resistant autoimmune hemolytic anemia. Furthermore, the patient developed cyanosis after ice incubating at the tip of the nose. Hence, the patient was diagnosed as CAD and he was successfully treated with glucocorticoids instead of anti-infection treatments. Hence, the patient was diagnosed with SS combined with secondary CAD. SS combined CAD are rarely reported, and they are both autoimmune diseases. The abnormal function of B lymphocytes and the production of autoantibodies might be the common pathogenesis of them. Cold agglutinin disease can lead to severe hemolytic anemia, even life-threatening. In clinical practice, timely recognizing and dealing with CAD might promote the prognosis of the patient.

Efetividade da máquina de perfusão hipotérmica versus armazenamento estático para preservação do rim de doador falecido: revisão rápida / Effectiveness of hypothermic machine perfusion versus cold static storage for deceased donor kidney preservation: rapid review

Tecnologia: máquina de perfusão hipotérmica. Indicação: Transplante renal de doador falecido. Pergunta: Qual a efetividade da máquina de perfusão hipotérmica (HMP) para a preservação do rim de doador falecido, quando comparada ao armazenamento estático a frio (SCS)? Objetivo. Avaliar a efetividade da máquina de perfusão hipotérmica na preservação do rim de doador falecido, em comparação com o armazenamento estático a frio. Métodos: Revisão de revisões sistemáticas (overview) do tipo revisão rápida. Foi realizado um levantamento bibliográfico nas bases de dados: PubMed, Embase, BVS, Epistemonikos, Cochrane Library e em bases de registro de protocolos de revisões sistemáticas e ensaios clínicos, utilizando descritores e estratégias de busca predefinidas. A avaliação da qualidade metodológica dos estudos incluídos foi feita através da ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: Duas revisões sistemáticas atenderam aos critérios de elegibilidade e foram incluídas na análise. Uma delas apresentou alto nível de qualidade metodológica. Conclusão: O uso da HMP para a preservação de rins de doadores falecidos foi associado a melhores desfechos clínicos relacionados à função retardada e à sobrevida do enxerto e foi considerado custo-efetivo, quando comparado ao SCS. Faz-se necessária a geração de evidências mais robustas acerca dos custos e benefícios do uso desta tecnologia no âmbito do SUS

Technology: hypothermic machine perfusion. Indication: Deceased donor kidney transplantation. Question: How effective is hypothermic machine perfusion (HMP) for preserving deceased donor kidneys compared to static cold storage (SCS)? Objective: To evaluate the effectiveness of the hypothermic machine perfusion in preserving the deceased donor kidney, compared to static cold storage. Methods: Rapid review of systematic reviews (overview). A bibliographic survey was carried out in the databases: PubMed, Embase, VHL, Epistemonikos, Cochrane Library and in databases of systematic review protocols and clinical trials, using predefined descriptors and search strategies. The assessment of the methodological quality of the included studies was performed using the AMSTAR-2 tool (Assessing the Methodological Quality of Systematic Reviews Version 2). Results: Two systematic reviews met the eligibility criteria and were included in the analysis. One of them performed a high level of methodological quality. Conclusion: The use of HMP for the preservation of deceased donor kidneys was associated with better clinical outcomes related to delayed graft function and graft survival and was considered cost-effective. It is necessary to generate more evidence about the costs and benefits of using this technology within the Brazilian Unified System of Healthcare (SUS)

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.

Effect of hypothermic machine perfusion on expression levels of inflammatory cytokines in rat kidney / 器官移植

Objective To evaluate the effect of hypothermic machine perfusion (HMP) on the expression levels of inflammatory cytokines in rat kidney. Methods Thirty male rats were randomly divided into the control (Control group), static cold storage group (SCS group) and HMP group, with 10 rats in each group. The velocity, intrarenal resistance and pH value of perfusion effluent were recorded during HMP. The expression levels of CXC chemokine ligand (CXCL)1, CXCL2, interferon (IFN)-β1, IFN-α4, CC chemokine ligand (CCL)2, CCL20, interleukin (IL)-17α, IL-17C and tumor necrosis factor (TNF)-α messenger RNA (mRNA) in renal tissues were evaluated by reverse transcription polymerase chain reaction (RT-PCR). Pathological changes of the kidney were observed by hematoxylin-eosin (HE) staining. Results During HMP, the velocity and intrarenal resistance remained stable, and the pH value of perfusion effluent was decreased slowly. RT-PCR showed that the relative expression levels of CXCL1, CXCL2, CCL2, CCL20, IL-17α, IL-17C and TNF-α mRNA in the SCS and HMP groups were higher compared with those in the Control group. Compared with the SCS group, the relative expression levels of CXCL1, CXCL2, CCL2, CCL20, IL-17α and TNF-α mRNA were up-regulated in the HMP group (all P<0.05). HE staining revealed that the morphology of renal cells was normal in the Control group, whereas evident epithelial necrosis, cytoplasmic vacuolation, brush border loss and epithelial shedding were observed in the SCS group. Compared with the SCS group, pathological changes in the HMP group were alleviated. Conclusions HMP may activate renal inflammation, and inhibiting the activation of inflammation during HMP is expected to further improve the effect of allograft preservation.