Clinical effect and action mechanism of Weicao Capsule (威草胶囊) in treating gout

Objective： To study the therapeutic effect of Weicao Capsule （威草胶囊, WCC） on gout. Methods： Two hundred gout patients were assigned to two groups. The treated group was treated with WCC and the control group was treated with Tongfengding Capsule （痛风定胶囊）. Both groups were given the respective treatments orally 3 times a day, 2 capsules each time with 2 weeks as one course and all patients received 2 successive courses of treatment. Changes of blood β2- microglobulin （13 2-M）, hemoglobin （Hb）, 24 h urinary protein （24 h UP）, pH value of urine and blood uric acid （BUA） as well as kidney function were observed. Results： After treatment, level of β 2-M got lowered significantly, Hb and 24 h UP, blood urea nitrogen, serum creatinine and the clearance rate of creatinine, as well as blood lipids all improved obviously in the treated group （all P〈0.01）, while these parameters remained unchanged in the control group （P〉0.05）. The pH value of urine was improved in both groups showing an insignificant difference between them （P〉0.05）. BUA was decreased in both groups with a decrease to a larger extent in the treated group （P〈0.01）. The total effective rate was 87% in the treated group, which was superior to that in the control group （62%, P〈0.05）. Conclusion： WCC has a favorable therapeutic effect on gout and its mechanism of action for improving renal function and reducing urinary protein could be related with the lowering of blood β 2-M, BUA and lipids.     

Clinical Observation on Effect of Kaixin Capsule （开心胶囊） in Treating 40 Patients with Diabetic Myocardial Ischemia

Objective： To observe the effect of Kaixin Capsule （开心胶囊, KXC） on myocardial ischemia and plasma endothelin （ET） level in patients with diabetic heart disease （DHD）. Methods： The 72 subjects for observation were randomly selected from inpatients whose diagnosis fit to the standard of DHD. The 32 patients allocated in the control group were treated with conventional Western medicine, and the 40 patients in the treated group were treated with conventional Western medicine in combination with KXC, with the therapeutic course for both groups as 60 days. Results： On ECG, the total effective rate and markedly ef- fective rate in the treated group was 85. 0% and 37. 5% respectively, higher than those in the control group＇s 68.7% and 28. 1% respectively, and showing significant difference between the two groups （P〈 0.05）. The level of ET in patients in both groups was significantly higher than normal range, after treatment, but reduced to different extent, and the comparison between them also showed that the difference was significant （P〈0.05）. Conclusion： KXC might, by way of inhibiting and blocking the release of ET, lower its level in plasma so as to improve the myocardial ischemic condition of patients with DHD.     

Effect of Xin’ anning Nasal Drop (心安宁滴鼻剂) in treating coronary heart disease with unstable angina pectoris

Objective： To observe the clinical efficacy of Xin＇anning Nasal Drop （XAND,心安宁滴鼻剂） in treating coronary heart disease with unstable angina pectoris （CHD-UAP）. Methods： Sixty patients with CHD-UAP were assigned, according to the randomizing number table, to two groups, the control group treated with conventional Western medicine, and the treated group treated with conventional Western medicine plus XAND. The clinical efficacy and the changes of S-T segment in resting EKG and total ischemia burden （TIB） in 24-h dynamic EKG were observed. Results： The clinical efficacy, including the effect of angina alleviation, its initiation, and the effect of TOM syndrome score reduction, were significantly superior in the treated group to those in the control group （ P〈0.05 or P〈0.01 ）. The degree and extent of myocardial ischemia were significantly improved in both groups （ P〈0.01 ）, but the improvement in the treated group was better than that in the control group （ P〈0.05）. Moreover, it was worth mentioning that the immediate effect in the treated group was better than that in the control group, and the reduction of TIB, the improvement in heart rate and myocardial oxygen consumption （ immediately after the first administration or by the end of the therapeutic course）, and systolic blood pressure after treatment in the former were all superior to those in the latter, showing significant difference （ P〈0.05 or P〈0.01 ）. Conclusion： XAND has a quick effect in alleviating angina in patients with CHD-UAP, and it is worthy of further studies and spreading in clinical practice.     

Clinical Effect of Fuzheng Jiedu Granule (扶正解毒颗粒) on Serum NO,NOS and Microelements in Patients with Coronary Heart Disease in Long-term Contact with Nickel

Objective: To study the clinical effect of Fuzheng Jiedu granule (扶正解毒颗粒, FJG) and its influence on serum nitric oxide (NO), nitric oxide synthase (NOS) and rnicroelements in patients with coronary heart disease who are in long-term contact with nickel. Methods: Sixty patients were randomly divided into two groups, the treated group and the control group, 30 in each group. Conventional Western medicinal treatment was applied to both groups, but to the treated group, FJG was given additionally by oral intake, and the therapeutic course for both groups was 4 weeks. Besides, a health control group was set up with 15 healthy subjects selected from the same area, who had no history of contact with nickel. Clinical symptoms of the patients and changes in their electrocardiogram (ECG) and serum levels of NO, NOS and microelements were observed before and after treatment. Results: The total effective rate on clinical symptoms in the treated group was 93.3% and that in the control group 63.3%, comparison between the two showing significant difference (P＜0. 05); the total effective rate on ECG in the two groups was 90.0% and 56.7% respectively, which also showed significant difference ( P＜0. 05). After treatment, levels of serum NO, NOS, Mg, Zn and Ca increased and those of Ni, Mn and Fe decreased significantly ( P＜0. 05 or P＜0.01) in the treated group, while in the control group, changes in these laboratory indexes were insignificant. Conclusion: FJG could lower the blood nickel level and regulate the unbalance of microelements, help restore serum NO and NOS in persons exposed to nickel and improve the clinical symptoms of patients with coronary heart disease and in long-term contact with nickel.     

Effect of Shengmai Injection (生脉注射液) on cardiac function and inflammatory reaction in patients with acute coronary syndrome

Objective： To confirm the effect of Shengmai Injection （生脉注射液, SMI） in improving cardiac function in patients with acute coronary syndrome （ACS） and to explore its influence on inflammatory reaction in patients. Methods： Ninety ACS patients were randomized into two groups, the control group treated with conventional therapy and the SMI group treated with SMI. The patients＇ cardiac function was noted and the content of high sensitive C-reactive protein （hs-CRP） in venous blood was measured before treatment and 1 week and 3 weeks after treatment, so as to observe and compare their changes between the two groups. Results： The cardiac output, stroke volume and ejection fraction in the SMI group after 3 weeks of treatment were all higher than those in the control group （P〈0.05）. The serum content of hs-CRP was reduced in both groups （P〈0.05）, but the reduction in the SMI group was more significant than that in the control group （P〈0.05）. Conclusion： SMI could improve the cardiac function and further inhibit the inflammatory reaction in patients with ACS.     

Effect of Jisuikang （脊髓康） on Kinetic Dysfunction in Patients after Spinal Injury

Objective： To explore the effect of Jisuikang （脊髓康, JSK） on kinetic dysfunction in patients after spinal injury. Methods： Eighty-four patients with spinal injury were assigned equally, according to a randomizing digital table to the treated group and the control group. Conventional treatment was given to both groups, and JSK was additionally given to the treated group. Changes of various kinetic function concerning parameters including kinetic score, grades of spinal injury, effectiveness of the treatment and available recovery rate in patients allocated in the treated group and the control group were observed and compared in the way issued by Association of Spinal Injury of America （ASIA）. Results： Better effects were shown in the treated group than those in the control group in improving kinetic score （92.00 ± 9.95 scores vs 83.76 ± 24.12 scores）, ASIA overall improvement rate （69.05% vs 45.24%） and grades of effectiveness （P〈0.05）. However, the difference of available recovery rate between the two groups was insignificant （P〉0.05）. Cenclusien： JSK could prevent secondary alteration of spinal injury, promote the recovery and regeneration of nerve tissues, but could not restore the function of a necrotic spine.     

TCM Treatment of Male Immune Infertility——A Report of 100 Cases

To observe the therapeutic effect of Yikang Tang （益抗汤 Yikang Decoction） for male immune infertility. Methods： 100 cases of male immune infertility in the treatment group were treated with Yikang Decoction, while 100 cases treated with prednisone as the controls. Physical exam, routine semen and prostate exams, and exams for presence of anti-sperm antibody （AsAb） and mycoplasma in the serum or seminal plasma were carded out. Results： 1） The serum and seminal plasma AsAb levels decreased significantly （P〈0.01） in both the groups after treatment, with a more remarkable effect in the treatment group. 2） The sperm density and percentage of motile spermatozoa increased significantly in the two groups, but more significantly in the treatment group after treatment. The pregnancy rate of their wives was higher in the treatment group than that in the control group （P〈0.01）. 3） The sperm agglutination rate in the two groups decreased, but more significantly in the treatment group after treatment. 4） The improvement rate of the symptoms and the stability of the therapeutic effect were more dramatic in the treatment group than that in the control group （P〈0.01） after termination of drug administration. Conclusion： The Yikang Decoction has a more stable effect for male immune infertility than prednisone.     

Effect of Kang’ ai Injection (康艾注射液) on serum level of soluble interleukin-2 receptor and vascular endothelial growth factor in patients with esophageal carcinoma during radiotherapy

Objective： To observe the effect of Kang＇ai Injection （康艾注射液, KAI） on serum level of soluble interleukin-2 receptor （sIL-2R） and vascular endothelial growth factor （VEGF） in patients with esophageal carcinoma （EC） during radiotherapy （RT）, and to investigate its synergistic effect with RT and its influence on immunological function of the body. Methods： One hundred and seventy patients with EC, who had missed the chance of surgical operational therapy, were assigned to the treated group （90 cases） and the RT group （80 cases）, and at the same time a control group consisting of 80 inpatients without tumors was set up. Patients in the RT group were treated with RT alone but KAI was given additionally to those in the treated group, with 50 ml given once per day via intravenous dripping, 15 days as one course, and 2 courses administered in total. The immediate therapeutic efficacy and changes of serum slL-2R and VEGF levels were observed, and the effect of KAI on patients＇ quality of life （QOF） was evaluated by Karnofsky scoring. Results： In 16 patients of the treated group it was completely remission （OR）, in 54 partially remission （PR）, in 18 it was stabilized disease （SD） and in 2 progressive disease （PD）, with the total effective rate （CR ＋ PR） as 77.8%, while in those of the control group it was 12, 46, 18, 4 and 72.5%, respectively, the immediate therapeutic efficacy in the treated group was somewhat better than that in the RT group, but showed no statistical significance （P〉0.05）. Serum levels of slL-2R and VEGF in all the patients before treatment were higher than those in the control group, which were decreased after treatment in both groups （P〈0.05）, but the improvement in the treated group was better than that in the RT group, showing significant difference （P〈0.05）, and patients＇ QOF improved more significantly in the former as well （62.2 % vs 40.0%, P〈 0.05）. Conclusion： KAI in combination with RT in treating patients with EC could enhance the immunological function of patients, improve their QOF and enhance their sensitivity to RT.     

Application of kushenin on patients with chronic hepatitis C after renal transplantation

Objective： To evaluate the efficacy of kushenin in treating patients with chronic hepatitis C after renal transplantation. Methods： Fifty-five patients were randomly assigned by lottery to the treatment group （29 cases） and control group （26 cases）. The same immunosuppression therapy was given to all patients in both groups. Patients in the treatment group were treated with kushenin 0.6 g once a day, while those in the control group were treated with conventional liver protective agents such as vitamins. The treatment duration of both groups was 3 months. The incidences of serious hepatitis and acute rejection reaction, serum biochemistry parameters including indicators of liver and kidney functions, hepatic fibrosis index, and serum HCV-RNA were compared between the two groups. Results： （1） The incidence of serious hepatitis in the treatment group and the control group was 3.45% （1/29 cases） and 11.54% （3/26 cases）, respectively, which was insignificantly different between the two groups （P=0.335）. （2） The incidence of acute rejection in the treatment group was 6.90% （2/29 cases） and that in the control group was 7.69% （2/26 cases）, showing insignificant difference （P=0.335）. （3） The differences in serum alanine aminotransferase （ALT）, direct bilirubin （DBIL）, hyaluronic acid （HA）, propeptide collagen type Ⅲ （PC Ⅲ）, laminin （LN）, collagen type Ⅳ（Col Ⅳ） levels between the two groups were insignificant before transplantation （P〉0.05）, while the above-mentioned parameters in the treatment group were significantly lower than those in the control group after transplantation （P〈0.05）. The difference in serum creatinine （SCr） and endogenous creatinine clearance rate （CCr） between the two groups was insignificant before and after transplantation （P〉0.05）. （4） The negative conversion rate of HCV-RNA in the treatment group was 31.03% （9/29 cases）, significantly higher than the value of 11.54% （3/26 cases?     

Clinical observation on treatment of hyperplasia of mammary gland by Lirukang Granule (利乳康颗粒)

Objective:To explore the effi cacy and mechanism of Lirukang Granule(利乳康颗粒,LRKG) in treating hyperplasia of mammary gland(HMG).Methods:One hundred patients with HMG were randomly assigned to two groups,50 in each group.The patients in the treated group were orally administered with LRKG thrice a day,one package each time,and those in the control group were given orally Rukuaixiao Tablet(乳块消,RKX) thrice a day,4 tablets each time.The therapeutic course for both groups was 4 months.The clinical eff icacy,pain alleviating rate,as well as changes of local sign and symptom scores were observed before and after treatment.The changes of serum estradiol(E2),progesterone(P),testosterone(T),follicle stimulating hormone(FSH),luteinizing hormone(LH) and prolactin(PRL) in some randomly selected patients(24 patients in the treated group and 24 in the control group) before and after treatment were measured with radioimmunoassay.Results:The total clinical effi cacy in the treated group was superior to that in the control group,signifi cant difference was shown between the two groups(P<0.01).The cure-effective rate and total effective rate in the treated group were 70.0%and 88.0% respectively,signif icantly higher than those in the control group(38.0% and 64.0%) respectively(P<0.01),and the pain alleviating rate in the treated group was also significantly higher in the former than that in the latter(88.0% vs 64.0%,P<0.05).Moreover,the treated group showed obvious superiority in improving the patients' symptom and sign scores(P<0.01),and abnormalities of gonadal hormone as compared with the respective items in the control group(P<0.01).Conclusion:LRKG has good effi cacy in the treatment of HMG,and its mechanism may be related to the regulation on endocrine and immune function.     

Clinical observation on treatment of Tourette syndrome by integrative medicine

Objective:To explore the clinical efficacy of integrative Chinese and Western medicine in treating Tourette syndrome(TS).Methods:Ninety children with TS were randomized into two groups by randomizing digital table method:the 60 patients in the treated group were treated by Ningdong Granule(宁动颗粒,NDG) plus haloperidol,and the 30 in the control group treated by haloperidol alone.The course for both groups was 6 months.Conditions of the patients were estimated before and after treatment with Yale Global Tic ...     

Effect of modified Wuzi Yanzong Granule (加味五子衍宗颗粒) on patients with mild cognitive impairment from oxidative damage aspect

Objective:To observe the effects of modified Wuzi Yanzong Granule(加味五子衍宗颗粒,WYG)on memory function and the activity of serum superoxide dismutase(SOD), malondialdehyde(MDA)levels,leukocyte mitochondrial DNA(mtDNA)deletion rate andβ-amyloid protein_(1-28)(Aβ_(1-28))in patients with mild cognitive impairment(MCI).Methods:Thirty-six patients with MCI were selected based on the internationally recognized Petersen's criteria,and equally and randomly assigned to two groups.The treated group was treated with WYG and the control group was treated with placebo for 3 months.In addition,20 healthy subjects were included in the study as the normal control group.Changes of memory function,SOD activity,MDA content,leukocyte mtDNA deletion rate and Aβ_(1-28)content were observed before and after treatment.Results: Compared with the normal control group,the memory quotient and SOD activity in patients with MCI decreased significantly(P<0.01),while MDA,Aβ_(1-28)levels and the leukocyte mtDNA deletion rate increased significantly(P<0.01).After treatment,levels of memory quotient and serum SOD activity increased while the serum MDA level,leukocyte mtDNA deletion rate and Aβ_(1-28)level decreased in the treated group compared with those before treatment(P<0.01,P<0.05).Meanwhile,leukocyte mtDNA deletion rate and Aβ_(1-28)content in the treated group were all lower than those in the control group(P<0.05).Conclusion:WYG could improve memory function in patients with MCI and the therapeutic mechanism is possibly related to the increased activity of anti-oxidase,the improved free radical metabolism and the alleviation of leukocyte mtDNA oxidation damage.WYG shows clinical significance in delaying the progression of MCI.     

Study on effect of Yishen Capsule (益肾胶囊) in preventing recurrence of chronic glomerulonephritis

Objective:To observe the effect of Yishen Capsule (益肾胶囊,YSC) on preventing the recurrence of chronic glomerulonephritis (CGN) and to explore its mechanism preliminarily.Methods: CGN patients were assigned to the treated group (61 cases) and the control group (48 cases) and all of them were orally administered with 4 mg of Perindopril twice a day,but 3 capsules of YSC,thrice a day, were given additionally to patients in the treated group.The therapeutic course for both groups was 18 months.The recurrence rate of CGN at the 6th,12th,and 18th month in the two groups was observed and compared,and the changes of 24-h urinary protein quantity and T-lymphocyte subsets before and after treatment were observed as well.Results:(1) Comparison of recurrence rate between the two groups showed insignificant difference at the 6th month,but it did show significant difference at the 12th and the 18th month,which was significantly decreased in the treated group than in the control group (P<0.05,P<0.01);(2) The 24-h urinary protein quantity at the 18th month decreased significantly in both groups (P<0.05,P<0.01),but in the treated group was more significant (P<0.01);(3) T-lymphocyte subsets showed no obvious change in the control group after treatment (P>0.05),while in the treated group,it showed significant increase in CD3,CD4 and CD4/CD8 (P<0.05 or P<0.01) and significant decrease in CD8 (P<0.05),and also the difference after treatment in T-lymphocyte subsets between the two groups was significant (P<0.05 or P<0.01).Conclusion:YSC has marked effects in reducing the recurrence of CGN and in decreasing urinary protein,and its mechanism might be related with its function in regulating the ratio of T-lymphocyte subsets to enhance the immunity of patients.     

Clinical observation on the treatment of male neoplastic anemia with Yixuesheng capsule (益血生胶囊) combined with recombination human erythropoietin

Objective:To explore the efficacy and mechanism of Yixuesheng capsule(益血生胶囊,YXS) combined with recombination human erythropoietin(RHE) in treating male neoplastic anemia(NA).Methods: Sixty-five patients were randomized into two groups,the 33 patients in the treated group treated with a combined therapy of YXS and RHE,and the 32 in the control group treated with RHE alone,all for 12 weeks.Related clinical indexes,including hemoglobin(Hgb),red blood cell(RBC),hematocrit(HMC),testosterone(T),estradiol (E_2)...     

贝伐株单抗与阿帕替尼分别联合替莫唑胺治疗复发性高级别脑胶质瘤的近期及远期疗效分析

目的 探究贝伐株单抗与阿帕替尼分别联合替莫唑胺（TMZ）治疗复发性高级别脑胶质瘤的近期及远期疗效。方法 选取2018年3月—2020年3月武汉市第一医院107例复发性高级别脑胶质瘤患者作为研究对象,按照随机数字表法分为贝伐株单抗组（53例）和阿帕替尼组（54例）。贝伐珠单抗组予以贝伐珠单抗联合TMZ治疗;阿帕替尼组予以阿帕替尼联合TMZ治疗。评估两组治疗3个周期后的临床疗效,比较两组血清VEGF、EGFR水平,分析给药期间两组的药物毒性反应,并随访记录两组总生存期（OS）和2年生存率。结果 阿帕替尼组治疗后客观缓解率和疾病控制率高于贝伐珠单抗组（P <0.05）;贝伐珠单抗组治疗前后血清VEGF和EGFR的差值高于阿帕替尼组（P <0.05）;贝伐珠单抗组治疗后血小板降低率高于阿帕替尼组（P <0.05）;贝伐珠单抗组治疗后高血压发生率低于阿帕替尼组（P <0.05）;截止随访时间,贝伐珠单抗组OS为13.5个月,2年生存率22.64%,阿帕替尼组OS为17个月,2年生存率44.44%,Kaplan-Meier生存曲线显示,阿帕替尼组生存率高于贝伐珠单抗组（P <0.05）。结论 相对于贝伐珠单抗联合TMZ治疗方案,阿帕替尼联合TMZ治疗复发性高级别脑胶质瘤疗效更为优越,且可延长患者生存期。     

良性前列腺增生合并迟发性性腺功能减退大鼠模型的构建

目的 探讨良性前列腺增生(BPH)合并迟发性性腺功能减退症(LOH)动物模型的建立方法,并分析其特点.方法 选取80只SD大鼠,随机分为对照组、BPH合并LOH组、BPH组、LOH组,每组均为20只.BPH合并LOH组给予环磷酰胺[20 mg/(kg·d)]腹腔内连续注射5d,而后给予丙酸睾酮[50 mg/(kg·d)]腹腔内连续注射28 d;BPH组以同等体积生理盐水代替环磷酰胺,LOH组以同等体积橄榄油代替丙酸睾酮,对照组以同等体积生理盐水代替环磷酰胺、同等体积橄榄油代替丙酸睾酮,给药方法同BPH合并LOH组.停药2d后,进行悬尾实验、负重游泳实验及交配实验,并通过断尾法取血以检测血清睾酮含量.完成全部操作后,通过颈椎脱臼法处死全部实验动物,解剖观察前列腺、称量并行组织病理学检查.结果 LOH组、BPH合并LOH组、对照组、BPH组大鼠平均前列腺指数分别为1.58±-0.13、2.93±0.19、2.33±0.13、3.23土0.11,血清睾酮含量分别为(4.91±1.06)、(9.52±1.02)、(12.59±0.70)、(19.69±0.56) ng/mL,悬尾挣扎次数分别为(97.40±15.86)、(120.40±14.06)、(223.83±16.51)、(235.29±18.77)次,各组间差异均有统计学意义(P＜0.05,P＜0.01);LOH组、BPH合并LOH组、对照组、BPH组大鼠平均负重游泳时间分别为(74.27±9.29)、(167.47±23.35)、(302.33±30.10)、(261.59±35.13)s,嗅阴次数分别为(1.53±0.52)、(3.07±0.88)、(9.17±1.30)、(9.59±1.12)次,除对照组和BPH组差异无统计学意义外,其余各组间差异均有统计学意义(P＜0.01);LOH组、BPH合并LOH组、对照组、BPH组大鼠平均骑跨次数分别为(0.33±0.49)、(0.47-±-0.52)、(2.11±0.47)、(2.29±0.47)次,除对照组与BPH组、BPH合并LOH组与LOH组差异无统计学意义外,其余各组间差异均有统计学意义(P＜0.01).结论 通过腹腔注射环磷酰胺及丙酸睾酮可获得BPH合并LOH大鼠模型.     

Clinical experience in treatment of Amanita mushroom poisoning with Glossy Ganoderma Decoction (灵芝煎剂) and routine Western medicines

Objective:To assess the effects of treatment of Amanita mushroom poisoning with Glossy anoderma Decoction(灵芝煎剂,GGD).Methods:Twelve patients with acute Amanita mushroom poisoning received conventional treatment(penicillin and reduced glutathione) combined with oral administration of GGD(treated group),which was prepared out of 200 g Glossy ganoderma decocted in water to 600 mL,and 200 ml was given once,three times a day for 7 successive days;while conventional treatment alone was given to the other 11 patients assigned to the control group.The therapeutic eff icacy and changes in serum levels of total bilirubin(TBil),bile acids(BA),alanine transaminase(ALT),and aspartate transaminase(AST) activities in the two groups were compared.Results:The cured-markedly effective rate in the treated group was more signif icant than that in the control group(P<0.01).Elevation in TBil,BA,ALT,and AST activities were observed in both groups 3 days after poisoning,which progressively increased thereafter in the control group.In the treated group,they reached their peak on the 3rd day and then declined gradually.The differences between pre-treatment and post-treatment in both groups were obviously signif icant(P<0.01),so were the differences between the two groups at corresponding time points(P<0.01).Conclusion:GGD shows excellent clinical eff icacy in the treatment of acute Amanita mushroom poisoning and can reduce mortality signif icantly.     

Study of Androgen and Androgen Receptor in Relation to Insulin Resistance in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the mostcommon endocrinopathies of premonopausal womenwith the incidence rate being5 % to2 1 % [1,2 ] .Thedisorder is characterized by anovulation,hyperandro-genism,hyperinsulinism and obesity.Many studiessuggested that insulin resistance play an importantrole in the pathogenesisof PCOS,butthere wasveryfew investigations about androgen and androgen re-ceptor in relation to insulin resistance.The purposeof this study was to investigate the role of serum an…