Theecosystemfor a discipline is a complicated system consists of all the relative groups and the external environment of knowledge innovation,which the descipline is dependent upon It is a dynamic integrated system that the cluster of internal and external factors co-constitute,co-evolve and co-develope.The article studied the conditions and mechanisms for knowledge innovation of the ecosystem.

Object To identify the differences of chemical constituents of Dragon's Blood obtained by different extract processing. Methods The mentioned Dragon's Blood was analyzed by TLC, UV spectro photometry, and HPLC. Results The contents of dihydrochalcone in Dragon's Blood by the new extract processing were higher than that by traditional one's, while the contents of flavonoid and stibene were lower. Conclusion The heating free technology is a new technique that is an original with higher extract rate, and it is worth of spreading. It will promote the modernization of TCM.

Objective To study the expression and clinical significance of MMP-2 and MMP-9 protein and their relationships in human gastric carcinoma. Methods MMP-2 and MMP-9 protein expression were examined by two-step immunohistochemistry in 96 cases of human gastric carcinoma and paracancerous normal tissue. Results The expression rate of MMP-2 and MMP-9 in gastric carcinoma tissue was 72.9 %(70/96)and 66.7 %(64/96) respectively, which was significantly higher than those in the normal tissue (30.2 % and 31.3 % respectively, P<0.001). The expression of MMP-2 and MMP-9 was significantly correlated with site, depth invaded,TNM stage and lymph node metastasis of gastric carcinoma (P <0.05), and not with age, sex, size, histological differentiation of gastric carcinoma(all P>0.05). Conclusion There are close relationships between the expressions of MMP-2, MMP-9 in gastric carcinoma and pathological characteristics in clinic metastasis and prognosis. They may be used as important indexes to judge the biological behavior and prognosis of gastric carcinoma.

Objective:To investigate the values of genetic polymorphisms of excision repair cross-complementation group 1 (ERCC1), thymidylate synthase (TS), glutathione-S-transferase P1 (GSTP1) and methylenetetrahydrofolate reductase (MTHFR) in predicting the prognosis of advanced esophageal cancer patients treated with cisplatin/fluorouracil chemotherapy.Methods:One hundred and seven patients with advanced esophageal cancer were enrolled in this study, 98 of which were eligible for analysis. All patients received cisplatin/fluorouracil chemotherapy repeated every three cycles. Genetic polymorphisms examined herein included those in the genes coding ERCC1, TS, GSTP1 and MTHFR. Then the relationships between genetic polymorphisms and response rate (RR) and progression free survival (PFS) time were analyzed. Results:The patients with A/A or A/C genotype in ERCC1-C8092A had a higher response rate and longer PFS than the patients with C/C genotype (P=0.010,P=0.008);the patients with 2R2R or 2R3C or 3C3C genotype in TS-5'UTR had a higher response rate and longer PFS than the patients with 2R3G or 3C3G or 3G3G (P=0.007,P=0.018). There was no significant relationship between RR and PFS and other genetic polymorphisms. Conclusion:The advanced esophageal cancer patients with A/A or A/C genotype in ERCC1-C8092A and/or 2R2R or 2R3C or 3C3C genotype in TS-5'UTR were more sensitive to cisplatin/fluorouracil chemotherapy.

Objective: To explore the risk factors for Type 1 cardio-renal syndrome (CRS1) atfer ST-segment elevation myocardial infarction (STEMI). Methods: A total of 378 patients with STEMI were divided into two groups: a CRS1 group (n=98) and a non-CRS1 group (n=280). Clinical characteristics in the 2 groups were compared, and independent risk factors for CRS1 after STEMI were analyzed, and the effect of emergency Results: In the 378 STEMI patients, CRS1 was found in 98 patients (25.9%). Between the 2 groups, there was significant difference in 12 parameters, including age, history of diabetes, admission mean arterial pressure, admission systolic blood pressure, admission heart rate, Killip classification, left ventricular ejection fraction, baseline serum creatinine, baseline evaluated glomerular ifltration rate (eGFR), emergency PCI, β-blockers and angiotensin converting enzyme inhibitor/angiotensin, receptor antagonist (ACEI/ARB) application (allP<0.05). Multivariate logistic regression showed that age, history of diabetes, admission systolic blood pressure, Killip classification, reduced left ventricular ejection fraction, reduced eGFR, emergency PCI non-undergo and ACEI/ARB non-use were independent risk factors for CRS1 atfer STEMI. In the 256 patients undergoing emergency PCI, 50 patients (19.5%) had CRS1. hTe door-ball time and the amount of contrast agent in the CRS1 group were signiifcantly higher than those in the non- CRS1 group (bothP<0.05), but there was no signiifcant difference in the blood lfow in the “culprit vessel”atfer the PCI (P>0.05). Conclusion: CRS1 is a common complication of STEMI, which is associated with many factors. Immediate revascularization can reduce the incidence of CRS1 in patients with ST-segment elevation myocardial infarction.

Objective To evaluate the effectiveness and safety of quadruple regimen in preventing multi-day cisplatin-based chemotherapy-induced nausea and vomiting(CINV).Methods A total of 112 patients with malignant tumors who underwent cisplatin-based chemotherapy.According to the random number table method,patients were divided into the experimental group and the control group,with 56 cases in each group.The control group received cisplatin-based chemotherapy and triple therapy of fosapreitant dimeglumine,ondansetron hydrochloride and dexamethasone tablets.On this basis,the experimental group was given quadruple therapy containing olanzapine tablets.The occurrence of nausea and vomiting,as well as changes in FLIE and HAD scores were observed in both groups.Results The incidence of nausea and vomiting was lower from day 1(D1)to day 9(D9)after the beginning of chemotherapy in the experimental group than that in the control group(P＜0.05).The incidence of nausea and vomiting in the experimental group was lower than that in the control group.On D9 after the beginning of chemotherapy,the nausea score,vomiting score and total score of FILE were higher in the experimental group than those in the control group(P＜0.05).There were no significant differences in depression or anxiety score and incidence of adverse reactions on D1 and D9 after the beginning of chemotherapy between the two groups(P＞0.05).Conclusion The quadruple antiemetic regimen can improve the control rate of CINV induced by multi-day cisplatin-based chemotherapy,especially for the control of delayed nausea and vomiting,and improve the quality of life of patients during chemotherapy,with good safety.

Objectives:Present study aimed to use quantitative flow ratio based on Murray's law to analyze the risk factors of impaired side branches perfusion without naked eye visible slowing of blood flow in branches after interventional treatment of true bifurcation lesions of the coronary arteries. Methods:A total of 211 patients with non-left main coronary artery true bifurcation coronary artery disease who underwent percutaneous coronary intervention(PCI)in Hunan Provincial People's Hospital from June 2022 to September 2023 were continuously enrolled,with a total of 234 bifurcation lesions.The general clinical indicators,anatomical characteristics of coronary artery bifurcation lesions,branch protection methods,postoperative branch TIMI blood flow and other data were collected,and quantitative flow ratio(μQFR)was measured for postoperative branch blood vessels.Post-PCI μQFR<0.8 was considered as impaired branch perfusion and was included in the postoperative impaired branch perfusion group(n=51,53 branch lesions).Patients with μQFR≥0.8 were included in the postoperative normal branch perfusion group(n=160,181 branch lesions).Multivariate Logistic regression analysis was used to evaluate the effects of various clinical and anatomical factors on branch perfusion after PCI. Results:The post-PCI branch flow grading of all patients was TIMI grade Ⅲ.The postoperative branch μQFR of 53 vessels(22.6％)in the group with impaired postoperative branch perfusion was 0.70±0.10,and 0.93±0.05 in the group with normal postoperative branch perfusion,and the difference between the two groups was statistically significant(P<0.001).Compared with the postoperative group with normal branch perfusion,the postoperative group with impaired branch perfusion was featured with an elevated branch lesion length,branch reference diameter,postoperative branch opening diameter stenosis rate,postoperative branch narrowest lumen diameter stenosis rate,and a lower main branch-to-branch diameter ratio,preoperative branch narrowest lumen diameter stenosis rate,and preoperative main branch μQFR,all of which were statistically significant(all P<0.05).The postoperative branch opening diameter stenosis rate(r=-0.490,P<0.001),postoperative branch narrowest lumen diameter stenosis rate(r=-0.788,P<0.001),preoperative branch narrowest lumen diameter stenosis rate(r=-0.280,P<0.001),branch narrowest lumen diameter(r=-0.469,P<0.001),branch lesion length(r=-0.157,P=0.016)were negatively correlated with postoperative branch μQFR,and branch reference diameter(r=0.173,P=0.008),main branch/side branch diameter ratio(r=0.194,P=0.003),and branch opening diameter(r=0.328,P<0.001)were positively correlated with postoperative branch μQFR,and none of them were significantly correlated with clinical baseline data(all P>0.05).Multifactorial logistic regression analysis showed that following four factors were independent risk factors for impaired branch perfusion:postoperative stenosis of the narrowest branch lumen diameter(OR=1.228,95％CI:1.144-1.318,P<0.001),postoperative stenosis of the branch opening diameter(OR=1.110,95％CI:1.055-1.168,P<0.001),postoperative stenosis of the narrowest lumen diameter of the main branch(OR=1.115,95％CI:1.042-1.192,P=0.001),and length of the branch lesion(OR=1.121,95％CI:1.021-1.231,P=0016). Conclusions:Some of the patients whose branch flow reached TIMI grade Ⅲ after PCI are still faced the risk of hemodynamical impairment and should be functionally evaluated after PCI.The postoperative stenosis rate of the narrowest branch lumen diameter,postoperative stenosis rate of the branch opening diameter,postoperative stenosis rate of the narrowest lumen diameter of the main branch,and branch lesion length are the risk factors of branch perfusion impairment after PCI for coronary bifurcation lesions.

Objectives:to analyze the efficacy of percutaneous coronary intervention(PCI)for complex left main(LM)lesions combined with chronic total occlusion(CTO)of the right coronary artery. Methods:Ninety patients with complex left main lesions hospitalized in Hunan Provincial People's Hospital from January 2019 to December 2022 were consecutively included.According to the coronary angiographic vascular lesions,patients were divided into complex left main lesions combined with right coronary artery CTO(observation group,n=30)and complex left main lesions without right coronary artery CTO(control group,n=60).The baseline clinical data,intraoperative conditions,angiographic results,and postoperative follow-up results of the patients were analyzed and compared between the two groups. Results:Fifty-eight(64.4%)out of the 90 patients were male.There was no statistically significant difference between the two groups in terms of baseline clinical data(all P>0.05),left main lesion condition(P=1.000),left main calcification condition(P=0.249),and preoperative TIMI flow grading(P=1.000).In the comparison between observation group and the control group,intraoperative occurrence of no-reflow(3.3%vs.5.0%,P=1.000),hypotension(10.0%vs.8.3%,P=1.000),pericardial effusion(3.3%vs.0%,P=0.333),the percentage of intravascular ultrasound(IVUS)use(86.7%vs.90.0%,P=0.635),and the use of circulatory assist device(P=0.699),and the proportion of intraoperative coronary spinning(26.7%vs.21.7%,P=0.597)were all similar between the two groups.The median follow-up time was 14.50(11.83,15.85)months,and the differences in the incidence of major adverse cardiovascular events(MACE)such as recurrent angina,acute myocardial infarction,rebleeding,readmission for heart failure,and cardiac death(31.0%vs.32.1%,P=1.000)were not statistically significant between the observation group and the control group. Conclusions:PCI revascularization may be a viable approach for elderly patients with complex LM lesions with multiple underlying disease,and combined right coronary artery CTO,intolerance and reluctance to CABG.

Objective:To explore the differences of the diagnostic performance between the most recent 2018 version of liver imaging reporting and data system (LI-RADS v2018) and 2017 version (LI-RADS v2017) based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI to diagnose hepatocellular carcinoma (HCC) in high-risk patients.Methods:The clinical data and imaging findings of 237 patients in high-risk of HCC who underwent Gd-EOB-DTPA enhanced MRI and obtained postoperative or biopsy pathological results within one month from June 2016 to December 2019 in Tianjin Third Central Hospital were collected retrospectively. A total of 282 observations were obtained as study objects. Two independent radiologists blindly reviewed the preoperative MRI of all patients. The observations were categorized according to LI-RADS v2018 and v2017 respectively. The inter-observer agreement of the categorization between the two radiologists was tested by kappa analysis. With the LR-5 and LR-4+5 as the diagnosis of HCC, the sensitivity, specificity, accuracy, and Youden index of the LI-RADS v2017 and LI-RADS v2018 were evaluated with postoperative histopathological results as references. The McNemar test was used to compare the diagnostic performance between the two versions.Results:The two physicians had good consistency in the categorization of observations, with kappa values between 0.536 and 0.793. Using LR-5 as the criterion for HCC diagnosis, the Youden index (0.687) of LI-RADS v2018 was higher than that of v2017 (0.612). The sensitivity [80.6% (166/206)] and accuracy [82.6% (233/282)] were both higher than those of LI-RADS v2017 [70.4% (145/206) and 75.9%(214/282)] (χ2=19.048, 14.087, both P<0.001). The specificity was slightly lower [88.2%(67/76) and 90.8%(69/76), respectively], but there was no statistical difference (χ2=0.500, P=0.500). With LR-4+5 as the diagnosis of HCC, the diagnostic performance of the two versions was the same. The sensitivity [91.3% (188/206)] and accuracy [87.6% (247/282)] were higher, and the specificity [77.6% (59/76)] were lower than the LR-5 standard of LI-RADS v2018 (χ2=20.045, P<0.001; χ2=5.633, P=0.018; χ2=16.056, P<0.001), and the Youden index (0.689) was also higher than the LR-5 standard of LI-RADS v2018. Conclusions:Based on Gd-EOB-DTPA enhanced MRI, the LI-RADS v2018 has higher sensitivity and accuracy in diagnosing HCC than v2017. Correct use can provide more objective diagnostic evidence for the clinic.