Grounded in the traditional Chinese medicine (TCM) theory of visceral outward manifestation describing the Lung and Large Intestine being Externally-Internally Related (Zang-Fu Xiang Guan), previous research has revealed that a self-formulated TCM prescription Qingfei Huayu Tongfu Formula positively treats sepsis-related acute respiratory distress syndrome (ARDS). However, the effect of the therapeutic timing of Qingfei Huayu Tongfu Formula on the clinical outcomes and prognosis of sepsis-related ARDS remains unclear.
To explore the optimal timing of the Qingfei Huayu Tongfu Formula in the treatment of sepsis-associated ARDS and its impact on the treatment efficacy and prognosis.
A total of 208 patients with sepsis-associated ARDS diagnosed in the Intensive Care Unit, Affiliated Hospital of Nanjing University of Chinese Medicine from 2021 to 2023, and treated with Qingfei Huayu Tongfu Formula were retrospectively recruited. According to the time of the first application of TCM decoction, those who took Qingfei Huayu Tongfu Formula within 48 hours of the diagnosis of sepsis-associated ARDS were included the early intervention group (n=109), and patients who took Qingfei Huayu Tongfu Formula after 48 hours were included in the late intervention group (n=85). Fourteen patients were lost to follow-up. Clinical outcomes and prognosis were compared between groups.
The 28-day all-cause mortality rate in the early intervention group was significantly lower than that of the late intervention group (13.8% vs. 29.4%, P=0.001 4). The risk of death in the late intervention group was 2.11 times that of the early intervention group (HR=2.11, 95%CI=1.13-3.91, P=0.019). The median duration of mechanical ventilation was 12 (8, 23) days in the early intervention group, which was significantly shorter than 27 (13, 35) days in the late intervention group (P=0.035). Intra-group comparisons showed improvements in oxygen index for both groups post-treatment (P<0.001). C-reactive protein (CRP), procalcitonin (PCT), and white blood cell counts post-treatment were all significantly reduced in both groups compared to pre-treatment levels (P<0.05). After the intervention, the mean oxygen index in the early intervention group was significantly higher than that of the late intervention group[ (319.87±95.32) vs. (259.55±99.72), P<0.001]. After the intervention, the median CRP in the early intervention group was significantly lower than that of the late intervention group[19.39 (8.16, 44.47) mg/L vs. 38.01 (17.53, 86.05) mg/L, P<0.001]. Similarly, the median PCT concentration post-treatment in the early intervention group was significantly lower than that of the late intervention group[0.175 (0.089, 0.750) ng/mL vs. 0.460 (0.143, 1.850) ng/mL, P=0.004].
Early administration (within 48 hours after diagnosis) of the TCM formula Qingfei Huayu Tongfu Formula to treat sepsis-related ARDS can reduce the 28-day mortality and the length of mechanical ventilation, improve the oxygenation index, and reduce inflammatory responses.
Many patients with rheumatism seek Chinese herbal medicine (CHM). Currently, CHM is effective in treating rheumatoid arthritis (RA) and Sjogren's syndrome (SS), but there are few studies on whether CHM reduces the risk of readmission for rheumatoid arthritis with Sjogren's syndrome (RA+SS) .
To determine whether CHM can reduce the readmission risk ratio of rheumatoid arthritis with Sjogren's syndrome (RA+SS) .
a retrospective cohort design was used in this study, and the data were collected from the First Affiliated Hospital of Anhui University of Chinese Medicine hospital information system (HIS) from 2012 to 2021. All subjects were followed up until January 2022. They were divided into RA+SS patients and RA patients according to their disease conditions. RA+SS patients were divided into CHM users and non-CHM users according to drug use. Cox regression model was used to investigate the factors affecting the readmission of patients with RA+SS. Kaplan-Meier (KM) curve was used to compare the readmission ratio between the CHM group and the non-CHM group.
The incidence of liver dysfunction, chronic renal dysfunction, autoimmune hepatitis, the levelof rheumatoid factor (RF), and positive rates of anti-SS-A antibody (SSA) and anti-SS-B antibody (SSB) were higher in the RA+SS group than in the RA group, and the number of recurrent hospitalizations was higher in the RA group (P<0.05). Cox proportional risk model analysis showed that the adjusted HR for readmission risk of RA+SS in CHM patients was lower (0.45) (95%CI=0.28-0.71). Kaplan-Meier survival analysis showed that the readmission rate of RA + SS was higher than that of RA group (χ2=56.254, P<0.01). The readmission rate of CHM group was lower than that of non-CHM group (χ2=24.020, P=0.019), and the readmission rate of female patients in CHM group was reduced more significantly (χ2=20.577, P=0.002). The readmission rate of patients over 60 years of age in CHM group was reduced more significantly (χ2=6.583, P=0.006) .
The addition of CHM treatment to RA+SS patients on the basis of conventional treatment can reduce the need for readmission, especially for female patients or patients over 60 years old, and provide theoretical basis for clinical treatment of RA+SS patients.
Deficiency of fluid and blood is the main clinical manifestation of middle- and advanced-stage patients with esophageal cancer, but there are few reports about the metabolomic characteristics of esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood.
To investigate the metabolomic characteristics of esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood.
From April to December 2022, 35 esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood, were selected as the case group in the departments of TCM and Thoracic Surgery, the Fourth Hospital of Hebei Medical University, meanwhile 35 healthy volunteers were selected as the control group. Serum specimens were collected, and metabolomic characteristics was analyzed by ultra performance liquid chromatography-mass spectrometry, and then screened the differential metabolites metabolic pathways.
A total of 88 differential metabolites with substance secondary matching names were screened out; 5 key metabolic pathways with significant difference and 11 related differential metabolites were further screened out. The 5 key metabolic pathways were β-Alanine metabolism pathway, Sphingolipid metabolism pathway, Linoleic acid metabolism pathway, Glycine, serine and threonine metabolism pathway, and Arachidonic acid metabolism pathway. Of the 11 related differential metabolites, β-Alanine, Phosphatidylcholine, L-homoserine, and L-allothreonine were significantly down-regulated, whereas Carnosine, Linoleic acid, 9, 10-DHOME, Hydroxypyruvic acid, Arachidonic acid, Heparin B3, and Thromboxane B2 were significantly up-regulated.
There are metabolic pathways with significant difference and related differential metabolites in esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood, which mainly involved in metabolic abnormality of energy, such as amino acids and fatty acids.
