Tuberculosis （TB） is a major infectious disease that seriously endangers public health. In traditional Chinese medicine （TCM）， TB is considered to be caused by "exogenous latent tuberculosis pathogens"， and whether the disease occurs depends on the strength of healthy Qi. The disease course is characterized by five features： Hidden latency， pathological accumulation， triggering due to deficiency of healthy Qi， depletion of healthy Qi， and prolonged progression with difficulty in recovery. The latent stage is based on the fundamental pathogenesis of "specific latent pathogens concealed in the lung collaterals and waiting for the appropriate time to manifest"， which exhibits the temporal and spatial characteristics of latent pathogens. During this stage， Mycobacterium tuberculosis remains in a dormant state and maintains a dynamic balance with the host immune system. The triggering and progression stages are characterized by the core pathogenesis of "deficiency of healthy Qi initiating pathogenic factors and excessive pathogenic factors triggering disease". Immune dysfunction may lead to severe pathological damage to the structure of the lung collaterals. The key pathogenesis of the latent-retention stage is "persistent latent pathogens consuming healthy Qi"， which is also the core reason for the difficulty in treating initial TB onset， prolonged disease progression， and recurrent attacks. Based on the theory of latent pathogens， this study establishes a four-stage prevention and treatment system "with pathogenesis as the guiding principle and disease stages as the criteria". The corresponding therapeutic principles include tonifying Qi and nourishing Yin， clearing and transforming latent phlegm， regulating and tonifying the spleen and kidney， strengthening healthy Qi and replenishing the primordial Qi， nourishing Yin and reducing fire， suppressing and eliminating tuberculosis pathogens， tonifying deficiency， restoring primordial Qi， clearing residual pathogens， and eliminating pathogenic factors. Guided by the theory of latent pathogens， this article systematically elucidates the TCM connotation of M. tuberculosis invasion of the lung collaterals and the staged syndrome differentiation and treatment approach， providing theoretical foundations and practical guidance for the prevention and treatment of TB through integrated Chinese and Western medicine and offering new perspectives for the prevention and control of infectious diseases using TCM.

Objective:To evaluate the effect of robot-assisted laparoscopic technology via abdominal approach for patients with primary retroperitoneal tumors.Methods:A retrospective cohort analysis was conducted for the clinical data of 71 patients who underwent robot-assisted laparoscopic resection of primary retroperitoneal tumor via abdominal approach at the Department of Urology of Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from January 2015 to December 2023. There were 35 male and 36 female patients. The age ( M(IQR)) was 56(21) years (range: 21 to 83 years). The median tumor diameter was 46 (31) mm (range: 15 to 134 mm). Postoperative pathology revealed 58 benign and 13 malignant cases. Patients were divided into non-adherent group ( n=47) and adherent group ( n=24) based on whether the tumor was adhered to major organs or vessels. Perioperative and postoperative situation were compared between the two groups. Data comparisons were conducted using independent samples t-test for normally distributed continuous variables, Mann-Whitney U tests for non-normally distributed data, χ2 test or Fisher′s exact test for categorical variables. Kaplan-Meier survival analysis was employed to estimate 3-year recurrence or metastasis rate and 3-year mortality rate. Results:Operative time was 120(60) minutes (range: 45 to 440 minutes), intraoperative blood loss was 50 (80) ml (range: 10 to 2 000 ml). The median change of intraoperative mean arterial pressure was 40 (19) mmHg(1 mmHg=0.133 kPa)(range: 10 to 112 mmHg). Intraoperative blood transfusion was required in 7 cases, whereas 64 cases did not necessitate transfusion. The change in hemoglobin levels before and after surgery was (17.9±13.6) g/L (range:-16 to 53 g/L), and the median change in serum creatinine levels was 2.0 (14.5) μmol/L (range:-71.0 to 100.4 μmol/L). Postoperative fasting duration was 2.0 (1.5) days (range: 1 to 6 days), and the median hospital stay was 10.0 (7.5) days (range: 4 to 24 days). No perioperative mortality occurred in any of the patients. The non-adherent group had shorter operation time, less estimated blood loss, lower blood transfusion rate, smaller delta value of hemoglobin before and after surgery, larger delta value of creatinine before and after surgery, fewer postoperative complications, shorter postoperative fasting time, and shorter length of hospital stay than the adherent group(all P<0.05), while there was no significant difference in mean arterial pressure fluctuation between the two groups ( P>0.05). Follow-up data were available for 69 patients, with a median follow-up duration of 39 (43) months (range: 4 to 88 months). Among these patients, 40 completed the 3-year follow-up. The 3-year recurrence or metastasis rate was 10.14%, and the 3-year mortality rate was 2.90%. Conclusions:Robot-assisted laparoscopic technology via abdominal approach for resection of primary retroperitoneal tumors is safe and feasible. It can also achieve secure surgical outcome for primary retroperitoneal tumors adherent to surrounding organs or vessels, albeit with increased surgical complexity and slower postoperative recovery compared to non-adherent cases.

Objective:To evaluate the effect of robot-assisted laparoscopic technology via abdominal approach for patients with primary retroperitoneal tumors.Methods:A retrospective cohort analysis was conducted for the clinical data of 71 patients who underwent robot-assisted laparoscopic resection of primary retroperitoneal tumor via abdominal approach at the Department of Urology of Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from January 2015 to December 2023. There were 35 male and 36 female patients. The age ( M(IQR)) was 56(21) years (range: 21 to 83 years). The median tumor diameter was 46 (31) mm (range: 15 to 134 mm). Postoperative pathology revealed 58 benign and 13 malignant cases. Patients were divided into non-adherent group ( n=47) and adherent group ( n=24) based on whether the tumor was adhered to major organs or vessels. Perioperative and postoperative situation were compared between the two groups. Data comparisons were conducted using independent samples t-test for normally distributed continuous variables, Mann-Whitney U tests for non-normally distributed data, χ2 test or Fisher′s exact test for categorical variables. Kaplan-Meier survival analysis was employed to estimate 3-year recurrence or metastasis rate and 3-year mortality rate. Results:Operative time was 120(60) minutes (range: 45 to 440 minutes), intraoperative blood loss was 50 (80) ml (range: 10 to 2 000 ml). The median change of intraoperative mean arterial pressure was 40 (19) mmHg(1 mmHg=0.133 kPa)(range: 10 to 112 mmHg). Intraoperative blood transfusion was required in 7 cases, whereas 64 cases did not necessitate transfusion. The change in hemoglobin levels before and after surgery was (17.9±13.6) g/L (range:-16 to 53 g/L), and the median change in serum creatinine levels was 2.0 (14.5) μmol/L (range:-71.0 to 100.4 μmol/L). Postoperative fasting duration was 2.0 (1.5) days (range: 1 to 6 days), and the median hospital stay was 10.0 (7.5) days (range: 4 to 24 days). No perioperative mortality occurred in any of the patients. The non-adherent group had shorter operation time, less estimated blood loss, lower blood transfusion rate, smaller delta value of hemoglobin before and after surgery, larger delta value of creatinine before and after surgery, fewer postoperative complications, shorter postoperative fasting time, and shorter length of hospital stay than the adherent group(all P<0.05), while there was no significant difference in mean arterial pressure fluctuation between the two groups ( P>0.05). Follow-up data were available for 69 patients, with a median follow-up duration of 39 (43) months (range: 4 to 88 months). Among these patients, 40 completed the 3-year follow-up. The 3-year recurrence or metastasis rate was 10.14%, and the 3-year mortality rate was 2.90%. Conclusions:Robot-assisted laparoscopic technology via abdominal approach for resection of primary retroperitoneal tumors is safe and feasible. It can also achieve secure surgical outcome for primary retroperitoneal tumors adherent to surrounding organs or vessels, albeit with increased surgical complexity and slower postoperative recovery compared to non-adherent cases.

Objective To explore the effect of decoction of Euphorbia fischeriana Steud.and jujuba(DEFSJ)against estrogen receptor(ER)negative(-)and ER positive(+)breast cancer via the PI3k/Akt pathway,and to provide a reference for the targeted treatment of breast cancer.Methods DEFSJ extract was prepared and analyzed using UHPLC-Triple Quad.DEFSJ containing serum(CS)was prepared via a serum pharmacology method.Different concentrations of DEFSJ-CS were applied to(ER-)MDA-MB-453 and(ER+)MCF-7 breast cancer cells in vitro for 48 h.The distribution of cells in different stages of the cellular cycle was evaluated using a Flow cytometer.DNA ladder assay was used to assess the degree of apoptosis,and the expression of PI3k/Akt pathway-related proteins was evaluated by Western blot assay.The expression of FoxO3a,FoxOla,and Bim mRNA was detected by Real-time quantitative PCR.Nuclear transposition of FoxO3a protein was analysed using a confocal laser microscopy.Results Five batches of DEFSJ extract were analyzed using UPLC,and the result showed that the preparation technology was feasible and the quality was controllable,ensuring the accuracy of the pharmacological experiment result.DEFSJ-CS blocked cells in the G2/M phase(P＜0.05,P＜0.01).Cells treated with DEFSJ-CS displayed the typical apoptotic ladder in the DNA ladder experiment.Compared with the negative control cells,the DEFSJ-CS group cells had decreased protein expression of p-PI3k,p-Akt,p-FoxO3a,and p-FoxO1a(P＜0.05,P＜0.01);increased protein expression of Bim(P＜0.05);decreased mRNA expression of FoxO3a and FoxO1a(P＜0.05,P＜0.01);increased mRNA expression of Bim(P＜0.05,P＜0.01);and enhanced nuclear translocation of FoxO3a protein.The data showed that DEFSJ-CS had a stronger effect on(ER-)MDA-MB-453 cells than(ER+)MCF-7 cells.Conclusions The regulatory effect of DEFSJ extract on anti-breast cancer involves the PI3k/Akt pathway,and the effect varies with phenotypic differences.

Consumptive thirst such as dry mouth and polydipsia,frequent urination polyuria,fear of heat and hyperhidrosis and loss of other body fluids,yin deficiency and internal heat expression,and irritability and other abnormal emotional symptoms are common.The Synopsis of Golden Chamber need to be further explored for the treatment of miscellaneous diseases.The dialectical thought has a high clinical application value.Lily disease treatment recommendations in the Synopsis of Golden Chamber are explored.The symptoms of lily disease are varied and uncertain,which are caused by the scattering and wandering aimlessly of heat pathogen.The pathogenesis of lily disease can be examined through external symptoms such as bitter taste in mouth,red urine,and faint and rapid pulse.Diabetes is also closely related to yin deficiency and internal heat,and the pathogenesis of the two is similar.Mental symptoms are common characteristics of lily disease and diabetes.The method taken from the Synopsis of Golden Chamber and Baihe-like prescriptions for the treatment of diabetes are effective.By identifying different patterns,symptoms,and indicators,we can select lily bulb,common anemarrhena,rhizome,figwort root,unprocessed rehmannia root,and other drugs to treat diabetes,in order to improve our understanding of lily disease and provide new ideas for diabetes treatment.

Objective To compare the efficacies of several commonly-used penetrating needling methods in treating post-stroke strephenopodia. Method Eighty-three patients with post-stroke strephenopodia were randomized into four groups, a control group intervened by conventional needling method (n=20), and the rest three groups were additionally intervened by different penetrating needling methods: penetrating group 1 [Qiuxu (GB40) towards Zhaohai (KI6), n=21], penetrating group 2 [Taibai (SP3) towards Shugu (BL65), n=21], and penetrating group 3 [Jiaoxin (KI8) towards Fuyang (BL59), n=21], to compare their effects on the function of ankle and lower extremity. Result The penetrating needling methods and conventional needling method all can significantly improve the function of ankle in patients with post-stroke strephenopodia (P<0.01). The effectiveness of penetrating group 1 was more significant than that of the rest groups (P<0.01), the effectiveness of penetrating group 2 was more significant than that of penetrating group 3 and the control group (P<0.05,P<0.01), and there was no significant difference in comparing the effectiveness between penetrating group 3 and the control group (P > 0.05). The penetrating needling methods and conventional needling method all can significantly improve the motor function of lower extremity in patients with post-stroke strephenopodia (P<0.01). The effectiveness of penetrating group 1 was more significant than that of the other groups (P<0.01), the efficacies of penetrating group 2 and 3 were more significant than that of the control (P<0.01), and there was no significant difference in comparing the effectiveness between penetrating group 2 and 3 (P>0.05). Conclusion Needling from Qiuxu towards Zhaohai and from Taibai towards Shugu can produce significant effects in improving ankle function and the motor function of lower extremity in patients with post-stroke strephenopodia, while needling from Jiaoxin to Fuyang doesn’t have notable advantage compared to the other penetrating needling methods and conventional needling method.

OBJECTIVETo prepare puerarin deoxycholate/phospholipid mixed micelle to increase the solubility of puerarin.

METHODSodium deoxycholate and soybean phospholipids were used to prepare puerarin mixed micelle through orthogonal design experiments. With the solubility, shape and particle size as the response indexes, the preparing process of puerarin mixed micelle was optimized.

RESULTThe optimized process for the puerarin deoxycholate/phospholipid mixed micelle was that the puerarin, soya phosphatidylcholine and sodium deoxycholate with the mole ratio of 3:2:4 should be dissolved in methanol-chloroform (1:1), and the solvents should be evaporated rotatively at 30 degrees C. The particle diameter of the mixed micelle was (64.8 +/- 13) nm (volume-weighted particle size distribution), and the solubility was 0.811 1 g x L(-1) in water at the room temperature, which was 22.3 times as that of the raw puerarin (0.036 4 g x L-1).

CONCLUSIONThe puerarin deoxycholate/phospholipid mixed micelle can improve the solubility of puerarin significantly.

Deoxycholic Acid ; chemistry ; Isoflavones ; chemistry ; Micelles ; Particle Size ; Phospholipids ; chemistry ; Plant Extracts ; chemistry ; Solubility

Objective To investigate the rationality and safety of dengzhanxixin injection used in elderly inpatients. Methods The clinical data of 986 inpatients including 620 males and 366 females were collected, and questionnaires containing age, sex, discharge diagnosis, symptoms, drug dosage, course of treatment, laboratory examination, adverse drug reaction and drug effect were analyzed. Results For the 986 cases, the average age was(74.3±7.5)years. The average dose of dengzhanxixin injection was (38.2±4.4) ml, once daily by intravenous drip, and the average period of treatment was (10.8±5.2) days. The adverse reaction rate was 0.81%. The levels of blood glucose and hemoglobin were decreased after treatment(t orμ=1226.5,2620.0, both P<0.05), but there were no statistical differences in the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (CREA), blood urea nitrogen (BUN) and white blood cell count (WBC) before and after treatment (t or μ=122.5, 405.0, 513.5, 996.5, 956.5, all P>0.05). Conclusions It is safe to use dengzhanxixin injection according to the medication description for elderly inpatients.