Internal Obstruction Research Articles

Heart failure: innovative understanding from traditional Chinese medicine (TCM) and treatment with classic TCM formulas

The prevalence of cardiovascular diseases in China has shown a rising trend. With the patient number of about 8.9 million, heart failure has brought a heavy burden to public health and wellness. Despite the modern medical research progress in the pathogenesis and clinical treatment of heart failure, the patients with heart failure still suffer from recurrent episodes of dyspnea(requiring repeated hospital admissions), diuretic resistance, elevated creatinine levels due to prolonged diuretic use, and poor prognosis, among other major clinical and scientific issues. In traditional Chinese medicine(TCM), heart failure belongs to the category of "heart water". The research team has found that because of the changes in the modern disease spectrum, the differences between ancient and modern physical constitutions, and the use of anti-heart failure drugs in modern medicine, the pathological process of heart failure has been altered, and the symptoms of some patients have become unobvious. As a result, the etiology and pathogenesis of heart failure have undergone major changes. The disease causes include external pathogen attack, emotional disorders, excessive labor injury, medication-induced damage, dietary disorders, water-dampness stagnation, and endowment insufficiency. These causes are closely related to the infection aggravation-induced heart failure, cardiac and psychological diseases, and heart volume overload in modern medicine. The pathogeneses of heart failure include edema due to Yang deficiency and water retention turning into heat in the acute stage and liver depression and Qi stagnation, heart Qi deficiency, kidney Yang deficiency, Qi deficiency in lung and spleen, phlegm and water retention, and internal obstruction due to blood stasis in the remission stage. The corresponding treatment strategies were recommended as follows: Zhenwu Decoction for edema due to Yang deficiency, Mufangji Decoction for water retention turning into heat, Chaihu Longgu Muli Decoction for liver depression and Qi stagnation, Guizhi Decoction for heart Qi insufficiency, Shenqi Pills and Yougui Pills for kidney Yang deficiency, Yupingfeng Powder, Lizhong Decoction, Buzhong Yiqi Decoction, and Guipi Decoction for Qi deficiency in lung and spleen, Fangji Huangqi Decoction, Wuling Powder, Linggui Zhugan Decoction, and Tingli Dazao Xiefei Decoction for internal obstruction due to phlegm and water retention, Guizhi Fuling Pills and Danggui Shaoyao Powder for internal obstruction due to blood stasis. The clinical treatment should follow the principle of considering both pathogenesis and pathology as well as both medicine nature and mechanism. The TCM concept of secondary prevention with TCM formulas for replenishing deficiency should be adopted. The treatment based on the principle and concept above will improve the patients' quality of life, reduce the number of hospital admissions, ameliorate diuretic resistance, and improve the clinical outcomes.

Summary of Professor HUANG Jinchang's experience of electroacupuncture at Baliao acupoints for low anterior resection syndrome of rectal cancer

This paper introduces Professor HUANG Jinchang's experience in treating low anterior resection syndrome (LARS) of rectal cancer. Based on the clinical experience in treating fecal incontinence after rectal cancer surgery, Professor HUANG Jinchang proposes that the primary pathogenesis of LARS is spleen-kidney yang deficiency with internal obstruction of damp turbidity. The treatment approach should focus on strengthening the spleen, warming the kidney, and eliminating turbidity. The Baliao acupoints are specifically selected to eliminate turbidity, promote yang , facilitate the qi flow of the viscera, and regulate the opening and closing of the anus. Emphasis is placed on deep needling at the Baliao acupoints, with flexible acupoint selection based on accompanying symptoms. Additionally, moxibustion and bloodletting cupping are used to restore regular bowel movements and improve the quality of life for patients who have undergone anus-preserving surgery for rectal cancer.

Thrombosis of the superior vena cava in a patient with an implanted cardioverter–defibrillator: A case report

BACKGROUND: Superior vena cava syndrome results from the occlusion of blood flow in the superior vena cava due to external compression, internal obstruction, or infiltration of the vessel wall by a tumor. Although thrombotic complications caused by electrodes of cardiac implantable devices are uncommon in clinical practice, their incidence has been increasing due to the increasing need for such devices, which effectively correct the compromised electrical or mechanical functions of the heart chambers. CLINICAL CASE DESCRIPTION: Herein, we have presented a case of superior vena cava thrombosis syndrome in a patient who had undergone cardioverter–defibrillator implantation for dilated cardiomyopathy. We have discussed the classification of superior vena cava syndromes, its pathogenesis, and the types of collateral circulation. CONCLUSION: As observed in our patient, the concurrent presence of chronic heart failure syndrome can make it challenging to recognize superior vena cava syndrome in the early stages of diagnosis.

In-hospital outcomes of patients with lung cancer with and without superior vena cava thrombosis: A nationwide analysis.

e23322 Background: Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. It may be caused by external compression or internal obstruction due to a thrombus or direct invasion by tumor cells. Though lung malignancy is the most common cause of SVCS, there is a lack of data on in-hospital outcomes in these patients. Methods: We queried the National Inpatient Sample 2018-2020 to identify hospitalizations with lung cancer including both small cell and non small cell lung cancer. Hospitalizations with diagnosis of acute SVC thrombosis were determined by using ICD-10 codes.Demographics and mortality rates were compared between two groups using chi square for categorical variables and t test for continuous variables. Multivariate regression analysis was further performed to study the impact of SVC thrombosis on mortality, LOS and total hospitalization cost. Results: A total of 2011620 hospitalizations with lung cancer were identified. Of these, 2855 (0.0014%) had acute SVC thrombosis. These patients were younger with a mean age of 63 years. African-Americans and Hispanics were in a higher proportion in the cohort of hospitalizations with SVC thrombus as compared to those without. (Table 1). Multivariate regression analysis revealed higher odds of mortality (OR-1.94; C.I: 1.53-2.47; P < 0.001), LOS (OR 1.66; C.I:1.20- 2.31; P < 0.005) and total hospitalization cost (26211.15; C.I:22183.56- 30238.74; P < 0.001) in lung cancer hospitalizations. Conclusions: Our study shows that SVCT, has higher odds of mortality, length of stay and total hospital cost. Though the general recommendation is to continue anticoagulation, sometimes patients may require endovascular stent placement with/without thrombectomy. Though rare, SCVT can be life threatening and requires prompt attention.[Table: see text]

Clinical experience of Tianxiong Granules in treatment of hypertension based on treatment principle of supressing Yang and promoting blood circulation

Hypertension is the most common chronic disease in clinics and has become the most common risk factor for cardiovascular diseases. Because of its high incidence rate, disability rate, and mortality, it has attracted worldwide attention. Despite continuous progress in modern medicine in the treatment of hypertension with new antihypertensive drugs such as Zilebesiran, a nucleic acid drug that acts on microRNA, direct renin inhibitors, and renal sympathetic blockade, the control rate is still not ideal. How to effectively prevent and control hypertension has become one of the urgent clinical challenges to be solved. Traditional Chinese medicine(TCM) has a long record of treating hypertension and has accumulated rich experience, including theoretical understanding, effective single medicine, compound medicine, traditional Chinese patent medicines, and classic famous prescriptions. In TCM, hypertension belongs to the categories of diseases such as dizziness and headache. Previous literature and clinical studies have found that hypertension has key pathogenesis such as fire syndrome, fluid syndrome, deficiency syndrome, and blood stasis syndrome. Among them, the hyperactivity of liver Yang is closely related to blood pressure fluctuations, blood pressure variability, inflammation, and sympathetic activity stimulation. Internal obstruction by blood stasis is closely related to the damage of target organs such as the heart, brain, and kidneys in hypertension. Therefore, the two key pathogenesis of liver yang hyperactivity and internal obstruction by blood stasis run through the entire process of hypertension. Previous studies have found that the effective empirical formula Tianxiong Granules, based on the principles of suppressing Yang and promoting blood circulation, originated from the classic formula Xiongqiong Tianma Pills in Yu Yao Yuan Fang. It is composed of Gastrodiae Rhizoma, Chuanxiong Rhizoma, Puerariae Lobatae Radix, Achyranthis Bidentatae Radix, and Cyathulae Radix and has significant therapeutic effects in the treatment of hypertension. The clinical indications include headache, dizziness, bloating, strong neck, and weak waist and legs. At the same time, it may be accompanied by poor speech, thirst, normal or loose stools, soreness in the waist and legs, lower limb pain, muscle and pulse spasm, menstrual and abdominal pain, dark red tongue, strong pulse strings, or straight and long pulse strings that pass through the mouth of an inch. In the combination rule, it can be used according to the different pathogenesis stages of hypertension patients. In the fire syndrome stage, it is often combined with Tianma Gouteng Decoction and Chaihu Jia Longgu Muli Decoction. In the fluid syndrome stage, it is often combined with Banxia Baizhu Tianma Decoction. In the deficiency syndrome stage, it is often combined with Liuwei Dihuang Pills and Shenqi Pills. In terms of dosage, it is important to focus on the main symptoms and adjust the dosage of key drugs based on blood pressure values. Some drugs can be used in sufficient quantities. By analyzing the compatibility of Tianxiong Granules, clinical application indications, combined formula experience, and dosage application experience, we provide effective treatment methods and more options for TCM to treat hypertension with Yang hyperactivity and blood stasis syndrome.

Analysis of traditional Chinese medicine syndrome types and frequency changes of CD8+ and CD25+ T cells in metabolic-related fatty liver disease.

This study aimed to observe and analyze the changes in traditional Chinese medicine (TCM) syndrome types and CD8+ and CD25+T cell frequencies of metabolic-related fatty liver disease. For this purpose, 100 patients with metabolic-related fatty liver disease and their TCM syndrome types who were screened for medical treatment were collected. Flow cytometry was used to detect the changes in the frequency of CD8+ and CD25+T cells in the peripheral blood of patients, as well as liver function, fasting blood glucose, and lipid index. The frequency differences of CD8+ and CD25+T cells in patients with different syndrome types were compared. To use partial correlation analysis to determine the correlation between CD8+, CD25+T cell frequencies and TCM syndrome types in patients. Results showed that a total of 30 cases of liver stagnation and spleen deficiency syndrome, 25 cases of phlegm turbidity internal obstruction syndrome, 20 cases of dampness heat stasis syndrome, and 25 cases of phlegm stasis mutual accumulation syndrome were included in the 100 MAFLD patients. There was statistical significance (P<0.01) in the comparison of ALT, AST, GGT, TC, TG, HDL-C, LDL-C, FPG, HOMA-IR, CD8+CD25+, CD8+CD25-, CD8-CD25+, and CD8-CD25- among patients with different TCM syndrome types. There is a positive correlation between TCM syndrome types and patients' CD8+CD25+, CD8+CD25-, and CD8-CD25+, while there is a negative correlation between them (P<0.05). From the chord diagram, the relationship between CD8+CD25+ and TCM syndrome types is the closest. The ROC curve was used to analyze and determine that the relevant standard for CD8+CD25+ in liver depression and spleen deficiency syndrome is <4.90%; The relevant standard for phlegm turbidity internal obstruction syndrome is 4.90%~7.88%; Damp heat stasis syndrome is 7.88%~8.20%; The syndrome of phlegm and blood stasis accumulation is more than 8.20%. The TCM syndrome types of metabolic-related fatty liver disease will vary with the frequency of CD8+ and CD25+T cells. In conclusion, TCM syndrome types are closely related to the severity of the patient's condition and immune function, providing a new perspective and means for understanding the pathogenesis of metabolic-related fatty liver disease and evaluating the condition.

Acoustic propagation simulation of closed cavity with obstacles based on finite volume method

The propagation characteristics of sound in different cavities and cavity tube combinations are different. With reasonable design, sound will be dissipated in it to achieve noise elimination effect.Therefore, it is beneficial to optimize the structure design distribution to explore the sound field distribution inside the mechanical structure, so as to minimize the transmitted sound through the wall.Therefore, this paper mainly discusses the sound field distribution in closed cavity and the influence of obstacles on it, providing theoretical guidance for sound insulation design. Firstly, the advantages and disadvantages of different numerical simulation methods are discussed, and the feasibility of finite volume method in acoustic numerical simulation is expounded by comparing the methods used in commercial software. Secondly, based on the FVM, the influence of the location and number of obstacles in the closed cavity on the sound field distribution is emphatically analyzed. The simulation results show that acoustic waves are easy to overlap near obstacles with reflection boundaries. When the number of obstacles increases, the higher-order natural frequency increases. Therefore, in the internal design of the equipment, different sound absorbing materials can be laid on the internal obstruction to reduce the sound wave reflection.

Clinical thinking of acupuncture for snoring based on "disharmony qi leads to restlessness"

This study summarizes the clinical thinking of acupuncture for snoring based on "disharmony qi leads to restlessness". According to the pathological characteristics of qi stagnation and blood stasis, phlegm dampness and internal obstruction in snoring patients, combined with the etiology, pathogenesis and location of the disease, the innovative viewpoint of "disharmony qi leads to restlessness" is proposed. It is believed that the key to snoring treatment lies in "regulating qi ". In clinical practice, acupuncture can directly regulate the qi of the disease's location, regulate the qi of the organs and viscera, and regulate the qi of the meridians to achieve overall regulation of the body's internal and external qi, smooth circulation of qi and blood, and ultimately achieve the therapeutic goal of harmonizing qi, stopping snoring, and improving sleep quality.

Retention and mass transfer properties of the series of unbonded, amide-bonded, and alkylsulfobetaine-bonded ethylene bridged hybrid hydrophilic interaction liquid chromatography columns

This work investigates the link between the retentivity and the stationary phase to mobile phase mass transfer resistance of hydrophilic interaction liquid chromatography (HILIC) columns packed with the same base ethylene-bridged hybrid particles (BEH). The retention volumes, the plate heights, and the volume of the adsorbed water layer were measured for the ACQUITYTM UPLCTM BEHTM 130 Å HILIC Column (unbonded BEH), ACQUITY UPLC BEH 130 Å Amide Column (amide group attached), and AtlantisTM Premier BEH 95 Å Z-HILIC (zwitterionic group attached) Column. The method of Guo (toluene retention volumes in pure acetonitrile and in the HILIC eluent) was validated from the UNIFAC group-contribution method and applied to measure accurately the water layer volumes in these columns. A strong correlation was found between the retention volumes of most neutral polar analytes and the volume of the water layer adsorbed in the HILIC column. The fraction of the pore volume occupied by the water layer increases significantly from the BEH HILIC Column to the BEH Amide Column, and to the BEH Z-HILIC Column. This is explained by the water solvation of the attached ligands in the pore volume of the BEH Particles and to the smaller average mesopore size of the BEH Z-HILIC Particles. A second and strong correlation is also observed between the water content in the HILIC particle and the stationary phase to mobile phase mass transfer resistance of the HILIC columns at high mobile phase linear velocities. The measured intra-particle diffusivity normalized to the bulk diffusion coefficient decreased from 0.33 (BEH HILIC Column) to 0.10 (BEH Amide Column) and to only 0.03 (BEH Z-HILIC Column) for comparable retention of cytosine. These results are fully consistent with the higher viscosity of the internal eluent (higher water content) and higher internal obstruction for diffusion (smaller mesopores and internal porosity) in the BEH Z-HILIC Particles. Still, in gradient elution mode, the peak capacity was found to be 18% higher for the BEH Z-HILIC Column than that on the BEH Amide Column because the retention factors at elution were smaller when maintaining the same analysis time and starting eluent composition.

Prognostic value of desmoplastic stromal reaction, tumor budding and tumor-stroma ratio in stage II colorectal cancer

Existing high-risk factors are insufficient to accurately predict the postoperative recurrence risk of stage II colorectal cancer (CRC). The discovery of additional prognostic markers may be the key to improving the current status of stage II CRC treatment. The present study aimed to evaluate the relationship among desmoplastic reaction (DR), tumor budding (TBd), the tumor-stroma ratio (TSR) and their prognostic value for relapse-free survival (RFS). In this study, 207 patients with histologically confirmed stage II CRC from January 2012 to August 2018 were retrospectively reviewed from a single center; the cohort was divided into subgroups based on low or high TSR, and low, intermediate or high DR and TBd. Kaplan-Meier curve analysis and log-rank test were applied to examine RFS among subgroups. Univariate and multivariate Cox proportional hazards analyses were used to identify independent factors associated with RFS, and a nomogram was subsequently developed. Abnormal CA242, CEA, T4 stage, presence of hypertension, internal obstruction or perforation (IOP), lymphovascular or/and perineural invasion (PNI), number of nodes examined less than 12, low-frequency microsatellite instability (MSI-L), higher Ki-67 and immature DR were associated with a lower RFS. In multivariable analysis, DR (HR =2.111; 95% CI: 1.184-3.766; P=0.011), LVI (HR =1.919; 95% CI: 1.004-3.669; P=0.049) and PNI (HR =2.724; 95% CI: 1.362-5.448; P=0.005) were prognostic factors for RFS. On this basis, a nomogram that integrated DR and clinicopathologic predictors for predicting RFS passed the calibration and had an area under the curve of 0.826. The prognostic significance of DR outperformed TBd and TSR, therefore, we recommend adding DR as a biomarker in routine pathological reports. The novel nomogram combining these factors may be used as a reliable and effective tool for the prediction of RFS in stage II CRC, thus helping optimize therapeutic regimens under cooperation of oncologists and surgeons. Further multicentric studies are required for validation of this novel, simple and cost-effective prognostic model.

Mechanism of Tianhe Zhuifeng Ointment in treating rheumatoid arthritis with syndrome of internal obstruction and cold-dampness and compatibility principles based on "disease-syndrome-formula" association network

This study aims to explore the mechanism of Tianhe Zhuifeng Ointment in treating rheumatoid arthritis(RA) with syndrome of internal obstruction and cold-dampness and the compatibility characteristics based on the &quot;disease-syndrome-formula&quot; association network. A gene set associated with the clinical symptoms of RA was collected from Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine v2.0(TCMIP v2.0). The different expression gene set of RA with syndrome of internal obstruction and cold-dampness was screened out by transcriptomic expression profile detection and bioinformatics data mining of the comparison of RA patients with syndrome of internal obstruction and cold-dampness and healthy volunteers. The chemical composition information of 35 Chinese medicines from Tianhe Zhuifeng Ointment was collected from TCMIP v2.0 and Traditional Chinese Medicine Bank(TCMBank). The candidate targets were predicted based on the similarity principle of compounds structure. The interactive network of &quot;related gene of RA with syndrome of internal obstruction and cold-dampness-candidate target of Tianhe Zhuifeng Ointment&quot; was constructed. The core network targets were screened out by topological characteristics of calculating network, and the functional exploration was carried out based on Kyoto Encyclopedia of Genes and Genomes(KEGG) and Reactome Pathway Database. The compatibility mechanisms of various efficacy groups of Tianhe Zhuifeng Ointment were further explored. The results showed that the candidate targets of Tianhe Zhuifeng Ointment were mainly involved into the modules of &quot;immune-inflammation&quot; regulation, nervous system function, cell function, and substance and energy metabolism, etc. The mechanisms of various efficacy groups emphasized on different aspects. The group of dispelling wind and removing dampness-dredging channels and activating collaterals, the group of extinguishing wind and stopping convulsions, and the group of pungent analgesia regulated &quot;immune-inflammation&quot; system by warming meridians and dissipating cold. The group of activating blood and resolving stasis and the group of strengthening sinews and bones regulated &quot;immune-inflammation&quot; system by activating blood and dredging channels. The group of dispelling wind and removing dampness-dredging channels and activating collaterals, the group of extinguishing wind and stopping convulsions, the group of activating blood and resolving stasis, the group of strengthening sinews and bones, and the group of clearing heat and draining water affected the nervous system by invigorating Qi-blood and benefiting spirit. The group of dispelling wind and removing dampness-dredging channels and activating collaterals and the group of extinguishing wind and stopping convulsions regulated cell function and substance and energy metabolism by dispelling wind and eliminating cold-dampness. The group of activating blood and resolving stasis and the group of strengthening sinews and bones regulated the cell function and substance and energy metabolism by activating blood and strengthening sinews and bones. The results showed that Tianhe Zhuifeng Ointment exerted the comprehensive efficacy of dispelling wind, removing dampness, activating blood, removing stasis, warming meridians, dredging channels, and strengthening sinews and bones through adjusting the imbalance of &quot;immune-inflammation&quot;, regulating nervous system, cell function, and interfering with substance and energy metabolism, thus improving the syndrome of internal obstruction and cold-dampness. The findings of this study laid foundations for clarifying the therapeutic characteristics and clinical orientation of Tianhe Zhuifeng Ointment.

A Collection of Experiences of Famous Modern Gynaecologic Herbalists in the Treatment of Uterine Fibroids

Objective: To summarize the experience of famous gynecological Chinese doctors in treating uterine fibroids and the rules of medication in recent times. Methods: To study the literature of famous TCM doctors in gynaecology in recent times, to summarize and summarize the experience of treating uterine fibroids and the rules of medication. Results; the pivot of the woman's uterus is the Chong Ren; internal obstruction of blood stasis is the key to the pathogenesis, cold-dampness, liver-depression, phlegm-dampness and kidney deficiency are the main causes of the disease; activating blood circulation, resolving blood stasis and helping the righteousness is the main treatment method, and the treatment is based on the period and the individual; the Chong Ren induces the meridian medicine and focuses on regulating the emotions. Conclusion: By summarizing the experience of modern gynecologically renowned Chinese medicine practitioners in the treatment of uterine fibroids, we have developed therapeutic ideas for the treatment of uterine fibroids, which has guiding significance and practical value.

Dystocia in a wild Western Tiger Snake (Notechis scutatus occidentalis)

ABSTRACT Dystocia in reptiles is the retention of ova or foetuses within the female due to the failure of the female to complete parturition or oviposition. This disorder is commonly observed in captive reptiles, but has rarely been reported in wild reptiles. We observed a large internal obstruction in an adult female Tiger Snake captured as part of an ongoing population study. We failed to palpate out the object in the field, so we took the snake to a veterinary practice for professional assistance. All non-lethal methods of extracting the object were unsuccessful so we euthanised the specimen and post-mortem dissection revealed five mummified stillborn young lodged in a sealed reproductive tract. Reproductive abnormalities are frequent in Tiger Snakes and large proportions of litters can be comprised of unfertilised eggs, fertilised aborted eggs and stillborn young, yet none of these observations ever resulted in dystocia. It is interesting that this observation occurred in a snake from Herdsman Lake, Western Australia, where the Tiger Snake population is subjected to many anthropogenic stressors. We cannot determine what caused this case of dystocia but suspect it may have been caused by some sort of negative effect onset by the quality of the environment.

The effect of mesenteric defect closure on internal hernias and small bowel obstruction in patients undergoing colorectal surgery: A systematic review and meta-analysis

Abstract Objective Internal hernias (IH) are potentially severe complications after colorectal surgery and may lead to small bowel obstruction (SBO). However, the impact of mesenteric defect closure (MDC) on IH and SBO is currently unclear. The aim of this systematic review and meta-analysis was, therefore, to investigate the effect of MDC on IH and SBO in patients undergoing laparoscopic and open colorectal surgery. Methods Ovid Medline, PubMed, and Embase databases were searched. Studies reporting MDC in colorectal surgery were enclosed in the systematic review. Meta-analysis included studies that assessed the effect of MDC vs. non-closure (non-MDC) on IH and SBO. Meta-analysis was performed using a random effect model. Results of individual studies were summarized as ranges. Effect sizes were described as odds ratios (OR) with 95% confidence intervals (CI). Results Literature search revealed a total of 344 abstracts. Of these, 16 studies met the inclusion criteria. Included studies comprised a total of 10,068 patients and were published between 2009 and 2019. The incidence of IH and SBO as a composite outcome ranged from 0.0 to 3.5%, whereas the incidence of IH and SBO as single outcomes ranged from 0.0 to 2.7% and 0.0 to 1.7%, respectively. If IH occurred, reoperation was required in 66-100% with additional bowel resections in 20-100% and stoma-formation in 17-50%. The complication rate after reoperations was 25-100% and mortality 0-25%. Meta-analysis including four studies revealed no statistically significant effect of MDC on the composite outcome of IH and SBO (OR 0.25, 95% CI 0.04-1.77) and SBO as a single outcome (three studies, OR 0.48, 95% CI 0.04-5.49). The risk for IH as a single outcome was significantly lower in the MDC group (three studies, OR 0.15, 95% CI 0.02-0.92). Heterogeneity of the studies included was low to moderate for the composite outcome, as well as for IH and SBO as single outcomes (I2 40.3%, 0.0%, and 45.7%, respectively). Conclusion In current meta-analysis, MDC was not significantly associated with the composite outcome of IH and SBO in patients undergoing colorectal surgery. However, MDC significantly reduced the risk for IH. Based on these results, the benefit of MDC in colorectal surgery remains unclear and needs to be addressed in further studies.

Venous access for parenteral nutrition: Changes in Europe and North America over the past 12 years

This article provides an overview of the significant changes in clinical practices since the publication of the European Association for Clinical Nutrition and Metabolism guidelines on providing vascular access for parenteral nutrition regarding the choice of vascular access and prevention and treatment of the most common and important complications of long-term venous access, the catheter-associated bloodstream infection, and internal lumen obstruction of catheters.&#x0D; The preferred vascular access for parenteral nutrition for medium- to long-term parenteral nutrition is the tunneled central venous catheter, peripherally inserted central catheter, or a fully implantable port system, which is now largely determined by the underlying disease, near-term prognosis and patient comfort, and short-term parenteral nutrition in a hospital that largely depends on the capabilities of a particular medical institution. Strict adherence to modern standard measures for infection control and care of venous access and infusion lines, hand hygiene, and appropriate training of medical personnel, patients, and their caregivers are currently the most reliable and effective methods to prevent catheter-associated bloodstream infection. Taurolidine catheter lock is used as an additional measure.&#x0D; In most cases, the occlusion of the inner canal of the catheter can be eliminated by drug methods; however, its effectiveness directly depends on the correspondence of the chosen drug to the cause of the occlusion. Generally, changes in recent years have significantly reduced the incidence and risk of parenteral nutrition complications associated with vascular access.

Preparation of Oxymel (Sekanjabin-e) Buzuri Syrup as Vascular Opener (Mofatteh) Product and Its Standardization

Background: Sekanjabin-e buzuri consisting extracts of Chicorium intybus L. (Kasni), Cuscuta chinensis Lam. (Koshus), Apium graveolens L. (Karafs) and Pimpinella anisum L. (Anison) seeds is a Traditional Persian Medicine product. These drugs have many applications in traditional medicine, but they are more effective in opening vascular obstructions and related functions, especially in cardiovascular system. Purpose: In this study we prepared a proper Sekanjabin-e buzuri and developed a HPLC method for analysis of chlorogenic acid (CGA), as an herbal marker compound, for quality control and standardization in both Sekanjabin-e buzuri syrup and its ingredient sources. Methods: Sekanjabin-e buzuri is a group of oxymels that have many different formulations. A proper formulation has chosen from literature (from Gharabadin-e-salehi) and prepared. For standardization of Sekanjabin-e buzuri we developed a method for detecting chlorogenic acid content. A reversed phase MZ C18 column (150*3.0 mm, 5µm) using a mixture of acetonitrile-phosphoric acid 0.1% with gradient elution program for 20 minutes with flow rate of 1.5 ml/min with UV detection at 330 nm. Results: The chlorogenic acid Rt =5.1 minutes and linear over the range of 0.2-1.5 µg/ml, (R2 = 0.9996). The calculated LOD and LOQ of chlorogenic acid were 0.02 and 0.06 µg/ml, respectively. The concentration of chlorogenic acid was 7.69, 10.37, 2.25, 2.88 and 22.86 µg/ml for Chicorium intybus L., Cuscuta chinensis Lam., Apium graveolens L. and Pimpinella anisum L. seeds and Sekanjabin-e buzuri syrup, respectively. Conclusion: This standardized Sekanjabin-e buzuri syrup will be used as a vascular opener (Mofatteh) complementary product for opening internal organs obstruction e.g. promoting cardiovascular health.

Unusual presentation of ectopic thyroid causing respiratory distress

&lt;p&gt;Internal obstruction of the upper airways can be due to infection, anaphylactic reaction, congenital anomaly, foreign body inhalation or mass. The endoluminal presence of thyroid tissue in the trachea is a rare cause of airway obstruction. Only 14 well documented cases of intratracheal ectopic thyroid tissue have been reported in English literature since 1966. These lesions are mostly benign and nearly all patient present with symptoms of respiratory obstruction. This case report is of a lady who presented with upper airway obstruction due to subglottic ectopic thyroid tissue. An ectopic thyroid gland can develop if its normal migration is halted along this tract during embryogenesis. Subglottic location of ectopic thyroid is extremely rare. However, ectopic thyroid tissue in the larynx should be considered as a possible diagnosis causing upper airway obstruction.&lt;/p&gt;

Sclerosing encapsulating peritonitis: a rare case presenting as intestinal obstruction

Abdominal cocoon or sclerosing encapsulating peritonitis is a rare condition of unknown/ multifactorial etiology in which intestinal obstruction result from encasement of variable length of bowel by dense fibro collagenous membrane. A young adolescent girl reported with features of small bowel obstruction for more than one year. CT scan suggested features of internal obstruction. On exploration, she was found to have all viscous densely covered with a thick white gelatinous like membrane. The membrane was gently peeled off from the bowel. The patient recovered well and was discharged on an oral diet. Preoperative diagnosis of sclerosing encapsulating peritonitis is difficult and incidentally it is discovered on laparotomy. CECT is helpful in preoperative diagnosis. Main stay of treatment for this is surgery. Simple removal of the membrane after lysis of the adhesions produces optimal outcome. When the intestine is nonviable, bowel resection should be done. A high index of suspicion and appropriate radiology can prevent ‘surprises’ on laparotomy and unnecessary bowel resection. Simple removal of the membrane gives a good outcome.

Research Progress on Chinese Medicine Immunomodulatory Intervention for Chronic Primary Immune Thrombocytopenia: Targeting Cellular Immunity.

Chronic primary immune thrombocytopenia (CITP) is the most common acquired autoimmune disease that seriously threaten the physical and mental health of patients. Compared with Western medicine treatment, the intervention and treatment of Chinese medicine (CM) has shown certain therapeutic advantages. This paper reviewed the new pathogenesis progress on T cell immune abnormality in CITP, and CM studies on interferes effects of cellular immune regulation of CITP in recent years. Qi deficiency failing to control blood and internal obstruction of blood stasis are the two common types of CM syndromes in CITP patients, the corresponding treatments include invigorating Pi (Spleen), supplementing qi, activating blood, as well as tonifying qi and activating yang, regulating Gan (Liver) to invigorate Pi. The authors also mentioned the problems in the research field of CM for CTIP treatment, and put forward new ideas for the research in the future.

Introduction to Professor Ma Guiqin's experience in treatment of occupational pneumoconiosis

Occupational pneumoconiosis refers to a group of occupational pulmonary diseases,which is mainly characterized by diffuse fibrosis of lung tissue caused by inhalation of different pathogenic productive dust and retention in the lungs during occupational activities for a long period of time. According to the classification and catalogue of occupational diseases in China,it is mainly classified into 12 categories,such as silicosis,coal worker's pneumoconiosis,asbestos lung. At present,it is the most serious and most common occupational disease in China. The pathogenesis of pneumoconiosis is not clear,and there is still no effective therapy. In the past three years,it is found that traditional Chinese medicine is effective in the treatment of pneumoconiosis. Through collection of medical records,the regularity of the prescriptions used in the treatment of pneumoconiosis were analyzed and summarized. According to the traditional Chinese medicine theory,the clinical characteristics of recurrent cough,phlegm and asthma in patients with pneumoconiosis could be included in the categories of cough,wheezing,lung distension. Professor Ma Guiqin believes that the basic pathogenesis of pneumoconiosis is depression of the atmosphere,deficiency of the kidney,internal obstruction of phlegm,and adverse cardinality. According to its pathogenesis,the commonly used prescriptions,namely Shengxian Decoction,Jinshui Liujun Jian,Xiaochaihu Decoction,Sini Powder,Guomin Jian and syndrome differentiation-based modified medicines were expounded. In addition, " throat is the gateway to the lung and stomach",Professor Ma also believes that the prevention of pneumoconiosis should start with the throat,so as to curb the exacerbation or recurrence of the disease. Through clinical observation,if traditional Chinese medicine is properly used,and pathogenesis and syndrome differentiation-based treatment is provided,traditional Chinese medicine can relieve the clinical symptoms,and improve the exercise tolerance and the quality of life of patients with pneumoconiosis.