Clinical efficacy of fire needling combined with cupping therapy on herpes zoster of acute stage and the effect on Th17/Treg cellular immune balance / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between the combined therapy of fire needling and cupping, and western medication on herpes zoster of acute stage, as well as the effects on Th17 and Treg cells and inflammatory factors, i.e. IL-10 and IL-17 in the peripheral blood.@*METHODS@#Eighty patients with herpes zoster of acute stage were randomly divided into a combined therapy (fire needling plus cupping) group and a western medication group, 40 cases in each one. In the combined therapy group, the pricking and scattering techniques with fire needle were used at ashi points and Jiaji (EX-B 2) corresponding to the affected spinal segments; afterwards, cupping therapy was delivered. The combined treatment was given once daily. In the western medication group, valaciclovir hydrochloride tablet and vitamin B1 tablet were administered orally. The duration of treatment in each group was 10 days. Before each treatment from day 1 to day 10 and on day 11 , the score of symptoms and physical signs was observed in the two groups separately. Before each treatment from day 1 to day 10 and on day 11, 30, 60, the score of visual analogue scale (VAS) and skin lesion indexes were observed in the two groups. On day 60, the incidence of postherpetic neuralgia was recorded in the two groups. The levels of Th17 and Treg cells, Th17/Treg ratio in the peripheral blood, as well as serum levels of IL-10 and IL-17 were detected before and after treatment in the two groups. The clinical efficacy was compared between the two groups.@*RESULTS@#From day 6 to day 10 during treatment and on day 11, the scores of symptoms and physical signs in the combined therapy group were lower than those of the western medication group (P<0.05, P<0.01). On day 3, day 6 to day 10 during treatment and day 11, day 30, VAS scores in the combined therapy group were lower than those of the western medication group (P<0.05, P<0.01). On day 60, the incidence of postherpetic neuralgia in the combined therapy group was lower compared with that in the western medication group (P<0.05). The blister arresting time and scabbing time in the combined therapy group were shorter than those of the western medication group (P<0.05). After treatment, the level of Th17, and Th17/Treg ratio in the peripheral blood, as well as the serum levels of IL-10 and IL-17 were all lower in comparison with those in the western medication group (P<0.05). The curative and remarkably effective rate was 82.5% (33/40) in the combined therapy group, higher than 62.5% (25/40) in the western medication group (P<0.05).@*CONCLUSION@#The early application of fire needling combined with cupping therapy can effectively treat herpes zoster of acute stage, relieve pain, and reduce the incidence of postherpetic neuralgia, which may be related to reducing the levels of Th17 and Treg cells, and Th17/Treg ratio in the peripheral blood, as well as the serum levels of IL-10 and IL-17 so that the cellular immune balance is modulated.

Clinical features and prognosis analysis of 36 cases with post-infarction ventricular septal rupture / 心血管康复医学杂志

Objective :To explore clinical features ,therapeutic program and prognosis of patients with post-infarction ventricular septal rupture (PI-VSR).Methods :Clinical data of 36 PI-VSR patients ,who were treated in our hospital from Dec 2009 to Dec 2016 ,were retrospectively analyzed .According to in-hospital death condition ,patients were divided into in-hospital survival group (n＝14) and in-hospital death group (n＝22).General data were compared between two groups .Multi-factor Logistic regression analysis was used to analyze influencing factors for in-hospital death in PI-VSR patients .Results :All PI-VSR patients received routine medication ,10 cases received intra-aortic balloon pump (IABP) simultaneously , eight cases received transcatheter intervention to occlude VSR and stent im- plantation ,and two cases received ventricular septal repair surgery .In-hospital mortality of PI-VSR patients was 61.1%(22/36).Compared with in-hospital survival group ,there were significant rise in age [55 (46 ,64) years vs . 67 (52 ,82) years] ,percentages of diabetes mellitus (21.4% vs.59.1%) and renal insufficiency (42.9% vs. 90. 9%) ,and significant reductions in LVEF [41 (20 , 48 )% vs.31 (20 , 38 )%] and percentage of surgery (57.1% vs.9.1%) in in-hospital death group ,P＜0.05 or ＜0.01. Multi-factor Logistic regression analysis indica-ted that LVEF and surgery were independent protective factors for in-hospital death in PI-VSR patients (OR＝0.519 ,0.001 ,P＝0.032 ,0.023).Conclusion : PI-VSR is a rare fatal complication of myocardial infarction ,and therapeutic effect of conservative treatment is poor .Transcatheter interventional occlusion is an alternative transi-tional program that might replace surgery in PI-VSR treatment .

Association of alpha-adducin and angiotensin converting enzyme gene polymorphisms with salt-sensitive hypertension and early renal injury / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the association between the alpha-adducin gene G460T, angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphisms and salt-sensitive hypertension and early renal injury in Chinese people.</p><p><b>METHODS</b>The case-control study was performed in 200 essential hypertension (EH) and 200 normal control subjects in China. The 200 EH patients were divided into salt-sensitive(SS= 109) and non-salt-sensitive(NSS= 91) groups according to modified Sullivan's method. The genotypes of alpha-adducin gene were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The ACE genotypes were determined by PCR. The urine microalbum (Alb) in 200 EH subjects was measured by radioactive immunoassay.</p><p><b>RESULTS</b>(1) A higher frequency of alpha-adducin gene G460T TT in EH patients was observed (P< 0.05). No significant difference of the ACE gene I/D polymorphism was found between the EH patients and normal control (P> 0.05). There were significant differences in the alpha-adducin gene TT genotype and combined genotype of TT+ II between SS and NSS subjects (P< 0.05). (2) The levels of urine Alb/Cr in SS patients were significantly higher than that in NSS patients (P< 0.05); in SS group, the levels of urine Alb/Cr in ACE II and alpha-adducin gene TT genotypes were higher than that in ACE ID, DD genotype and alpha-adducin gene GT and GG genotypes. The levels of urine Alb/Cr in the group of alpha-adducin gene TT+ ACE II combined genotype were higher than that in other combined genotypes (P< 0.05).</p><p><b>CONCLUSION</b>The alpha-adducin gene TT genotype or combined with ACE II are significantly associated with SS hypertension. The alpha-adducin gene TT and ACE II genotypes might be genetic susceptibility factors to hypertension accompanying renal injury.</p>

Serum uric acid prevalence and changes post various antihypertensive agents in patients with essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To survey the prevalence of hyperuricacidemia and serum uric acid (SUA) changes and electrolyte changes after 6 weeks antihypertensive treatment with thiazide diuretics, losartan or losartan+hydrochlorothiazide (Hyzaar) in patients with essential hypertension (EH).</p><p><b>METHODS</b>A total of 1080 consecutive EH patients [662 males, mean age (60.9 +/- 12.3) years] who seeked for medical consultation in study hospitals in Fuzhou city during October 2004 and October 2006 were included in this study. The blood pressure before and after antihypertensive treatments were obtained in 1000 patients, and the renal function and electrolyte before and after antihypertensive treatments were obtained in 600 patients. Patients with SBP > 140 and/or DBP > 90 mm Hg 2 weeks after initial antihypertensive agents were cotreated with felodipine, patients with SBP > 140 and/or DBP > 90 mm Hg 4 weeks after initial antihypertensive agents were cotreated with beta and/or alpha blockers.</p><p><b>RESULTS</b>The prevalence of hyperuricacidemia in EH patients was 25.83% (279/1080). Body mass index (BMI) and creatinine were significantly higher while creatinine clearance rate (Ccr) calculated by Cockcroft-Gault equation was significantly lower in EH patients with hyperuricacidemia than EH patients without hyperuricacidemia (all P < 0.05). Similar antihypertensive effects were observed in EH patients treated with thiazide diuretics (n = 200), losartan (n = 324) or losartan + hydrochlorothiazide (Hyzaar, n = 476) and SBP was lower than 140 mm Hg in 69.40% and DBP was less than 90 mmHg in 85.30% EH patients 6 weeks after antihypertensive treatments. SUA was significantly increased (43.81 micromol/L +/- 71.79 micromol/L) low dose diuretics group (P < 0.01 vs. pretreatment), significantly reduced (44.96 micromol/L +/- 90.63 micromol/L) in losartan group (P < 0.0001 vs. pretreatment) and remained unchanged in Hyzaar group (7.46 +/- 84.72 micromol/L, P > 0.05 vs. pretreatment). Serum potassium was significantly decreased (0.30 +/- 0.44 mmol/L) in diuretic group (P < 0.01 vs. pretreatment) and remained unchanged in losartan group (+0.06 +/- 0.43 mmol/L) and Hyzaar group (-0.04 +/- 0.44 mmol/L, all P > 0.05 vs. pretreatment).</p><p><b>CONCLUSION</b>Hyperuricacidemia prevalence was 25.83% and associated with higher BMI and abnormal renal function in examined EH patients. The low dose thiazide diuretics could further aggravate hyperuricacidemia and induce hypopotassemia while losartan could reduce hyperuricacidemia in EH patients.</p>

[Use of direct portal vein puncture portography with modified TIPS treatment in patients with portal hypertension and gastro-esophageal varices bleeding].

OBJECTIVE: To explore a better procedure for transjugular intrahepatic portosystemic shunt (TIPS) in order to improve its safety and to extend its indications. METHODS: To puncture the right portal branch under sonographic guidance in 20 patients with portal hypertension and gastro-esophageal bleeding. The Teflon sheath with gold marker was put into the portal vein; anterior and lateral portography was made, portal pressure was measured and the gastric coronal vein was embolized. The gold marker was put into the portal vein puncture site and the Rups-100 was guided under the gold marker during the TIPS puncture procedure. Anterior and lateral portography was again made to make sure the puncture site was 2 cm away from the portal vein bifurcation. In some cases a 10F sheath was used to suck the thrombosis in the portal vein, and a balloon was used to dilate the parenchyma channel and then a stent was released smoothly. RESULTS: 20 reformed TIPS were successfully performed on all patients and their gastric-esophageal bleedings were controlled immediately. 37 punctures were made in 20 of those cases; the average puncture per patient was 1.85+/-0.67, lower than that of the traditional method. The pressure of the portal vein declined from (30.5+/-1.1) mmHg to (16.9+/-0.9) mmHg, P < 0.05, showing that the difference of portal vein pressure before and after the reformed TIPS was significant. 25 stents were placed, and no complications occurred during the procedure in any of the cases. CONCLUSION: Direct portal vein puncture portography and gold marker guided TIPS procedure is feasible and safe; the indications of TIPS could be further extended.