Objective: To investigate the effects of endothelin -1(ET-1) in the process of oral carcinogenesis. Methods: A sensitive SABC immuno-histochemical method and image pattern analysis technique were adopted in the examination of the localization and content of ET-1 in human oral mucosa from 10 cases of oral submucous fibrosis (OSF), 9 of oral leukoplakia (OLK),14 of oral squamous cell carcinoma(SCC)and 10 of normal control(NOR). Results: (1)Increaed expression of ET-1 was observed in the epithelial cells in OSF, OLK and SCC.The immune reative material was prominent within the cytoplasm and on the cell membrane of spinocells and basiocells.The proportion of ET-1 positive cells and cellular content of ET-1 in OSF,OLK and SCC were all significantly higher than that in NOR (P0.05). Conclusion: The cellular content of ET-1 probably increases in the process from premalignance to malignance.Its overexpression in OSF possibly indicates the potential malignance of epithelial cells.ET-1 may play a possible role in the pathogenesis of OSF,OLK and SCC.

0.05;1 or 2 vs 3,P

Objective: To summarize the experience in the treatment of candidiasis albicans. Methods: 95 cases aged 5 months～78 years old with candidiasis albicans were treated by fluconazole and polyactin A etc, the Candida albicans were examined by smear examination.Results: The rate of cure was 35.79 %, that of improvement was 57.89%, the clearance rate of Candida albicans was 80.59%.Conclusion: The Cadida albicans is opportunistic pathogen. Fluconazole is effective in the treatment of candidiasis albicans.

Objective To explore the clinical efficacy of transcutaneous autologous bone marrow transplantation in the treatment of delayed union after internal fixation of limb fracture. Methods 41 patients with delayed union after internal fixation of limb fracture with informed consent in our hospital were divided into two groups by number table,20 patients in control group were treated with conventional therapy,21 patients in observation group were treated with transcutaneous autologous bone marrow transplantation,the effects and the occurrence of complications of two groups were compared and observed. Results In observation group,excellent healing in 13 cases(61.9%),good in 7 cases(33.3%),failure in 1 case(4.8%),and in the control group,6 patients(30.0%),11 cases(55.0%),3 cases (15.0%),the difference between the two groups was statistically significant(u=4.1934,P＜0.05);the complication rate of the observation group was 9.5%,compared with 15.0% of the control group,there was no significant difference(x2=0.034,P＞0.05). Conclusion Transcutaneous autologous bone marrow transplantation in the treatment of delayed union after internal fixation of limb fracture had better efficacy and less complication.

Objective To evaluate the efficacy and safety of de novo combination of tenofovir (TDF) plus lamivudine (LAM) based highly active antiretroviral therapy (HAART) for HBV-HIV coinfected patients.Methods Sixty patients with HBV-HIV co-infections admitted to Wuxi Fifth People's Hospital and Shanghai Public Health Clinical Center during January 2009 and December 2012 were enrolled.The patients were randomly divided into TDF + LAM based HAART group (TDF + LAM group,n =30) and LAM based HAART group (LAM group,n =30).All patients were treated for 72 weeks.SPSS 17.0 was used to compare the ALT normalization rate,HBV DNA negative conversion rate,serological response,HIV RNA negative conversion rate and CD4 + lymphocyte counts elevation rate between two groups at 24-,24-,48-and 72-week.Drug resistance and adverse reaction were observed.Results ALT normalization rates in TDF + LAM group at 24-,48-and 72-week were 83.3％,90.0％ and 93.3％,respectively,which were higher than those in LAM group (x2 =5.079,4.812 and 5.455,P ＜0.05).After 48 weeks of treatment,there were 28 patients (93.3％) in TDF + LAM group with the elevation of CD4 + lymphocyte counts ≥ 150 cells/μL,the rate was higher than that in LAM group (21/30,70.0％) (x2 =5.455,P ＜ 0.05).HBV DNA negative conversion rates in TDF + LAM group at 12-,24-,48-and 72-week were 60.0％,90.0％,93.3％ and 96.7％,respectively,which were higher than those in LAM group (x2 =4.800,5.963,5.455 and 9.017,P ＜0.05).No drug resistance and severe adverse reaction was observed in TDF + LAM group.Conclusion TDF + LAM based HAART is better in HBV viral suppression and liver function normalization,and has lower HBV resistance and higher CD4 + T lymphoeyte counts elevation rate than LAM based HAART for HBV-HIV co-infected patients.

Objective:To explore the journey map of patients with chronic constipation during fecal microbiota transplantation.Methods:This study adopted phenomenological methods. From October to December 2023, purposive sampling was used to select chronic constipation follow-up patients who underwent fecal microbiota transplantation at the Intestinal Microecology Center of Shanghai Tenth People's Hospital as respondents for semi-structured interviews. Colaizzi 7-step analysis method and NVivo 11.0 software were used for data analysis.Results:A total of 15 interviewees were interviewed. During fecal microbiota transplantation, the journey map of constipation patients included stages, mood changes, touchpoints, themes, emotional experiences and opportunities. The patient's experience and needs were summarized into three themes and ten sub-themes, including pre-transplant adaptation disorders to new environments (unfamiliarity and confusion-admission coordination disorders, anxiety and expectations-diverse complex emotions, puzzle and helplessness-asymmetric doctor and patient information), effectiveness-related psychological and social experiences in transplantation (attention and expectations-longing for positive efficacy, perception of benefits and risk avoidance, shame and inferiority-treatment stigmatization experience, questioning and despair-unrealized expectations, treatment resistance-sensitive economic burden), post-transplant transition dilemmas (inaccessible medical services-lack of continuous treatment and nursing, disease recurrence troubles) .Conclusions:This study visualizes the experiences and needs of constipation patients during microbiota transplantation through a patient journey map and identifies multidimensional issues and needs of patients. Clinical medical and nursing staff should pay attention to the needs of patients at different stages of the treatment process when formulating intervention programs to improve the quality of fecal microbiota transplantation nursing.

Objective To investigate the diagnosis, treatment and prevention method for bile duct injury caused by laparoscopic cholecystectomy (LC). Methods Clinical data of 16 patients with iatrogenic bile duct injury caused by LC in Meizhou People's Hospital of Guangdong Province between January 2007 and January 2013 were retrospectively analyzed. Among them, 7 were males and 9 were females, aged 28-75 years old with a median age of 47 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The types of bile duct injury were classified according to the Strasberg bile duct injury classification. Treatments and postoperative clinical manifestations were analyzed, and clinical efficacy was observed. Results Among 16 patients, 9 were converted to open surgery during the surgery, and 7 underwent open surgery within 2 weeks after LC. There were 2 cases of type A bile duct injury, 7 of type D, 2 of type E1, 3 of type E2 and 2 of type E4. Two cases underwent bile duct repair alone, 1 underwent bile duct repair and stage Ⅱ endoscopic retrograde cholangiopancreatography (ERCP) balloon dilatation, 4 underwent bile duct repair + T tube drainage, 3 underwent bile duct anastomosis + T tube drainage, and 7 underwent Roux-en-Y anastomosis. One case died from multiple organ failure in the perioperative period. Recurrent mild biliary tract infection was observed in 1 case after surgery, biliary tract stenosis in 1 case and obstructive jaundice in 1 case, and all the other patients recovered. Conclusions For the bile duct injury caused by LC, surgeons should not only be familiar with the early diagnosis method, clinical classification and surgical treatment principles for iatrogenic bile duct injury, but also possess the capacity of coping with emergenices. During the surgery, surgeons should carefully identify the relationship among cystic duct, common bile duct and gallbladder ampulla, and perform precisely. Early diagnosis and appropriate treatment also play an important role.

Objective To explore the dilemmas faced by surrogate decision-makers of severe stroke patients in treatment decision-making,and to provide a basis for developing decision support strategies.Methods From April to December 2023,through phenomenological qualitative research with 16 surrogate decision-makers with severe stroke patients from ICU of the department of neurology in a tertiary hospital in Jing'an District,Shanghai.semi-structured in-depth interviews were used to examine the perceptions of decision-making on surrogate.Data were analyzed via Braun's style of thematic analysis.Results 4 themes and 10 sub-themes were identified.Theme 1:negative emotional dilemmas(urgent decision-making leads to anxiety,fear,and unknown stroke trajectory increases the sense of uncertainty).Theme 2:supportive environment dilemmas(lack of information support delays decision-making;lack of family support increases decision-making stress;insufficient economic support increases the burden of decision-making).Theme 3:the dilemma of weighing the pros and cons(difficult trade-offs between risk and reward,tough decisions between reality and ethics,conflicting choices of life and dignity).Theme 4:preference management dilemmas(practical difficulties in adhering to patient preferences,impediments to decision-making due to unknown patient preferences).Conclusion Surrogate decision-makers of severe stroke patients face multiple decision-making dilemmas.Healthcare professionals should provide emotional support in multiple ways and comprehensive support to reduce the decision-making dilemmas experienced by surrogate decision-makers,as well as implement death education for surrogate decision-makers and promote advance care planning to reduce their decision-making stress.

ObjectiveA rapid method for identification of chemical constituents in Baoyuantang reference sample was established in order to clarify the material basis of this formula. MethodBased on ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS） and self-established database information， the chemical components in Baoyuantang were systematically characterized and identified. The chromatography was performed on a Waters ACQUITY UPLC HSS T3 column（2.1 mm×100 mm， 1.8 μm） with mobile phase of 0.1% formic acid aqueous solution（A）-0.1% formic acid acetonitrile solution（B） for gradient elution（0-3 min， 2%-19%B； 3-8 min， 19%B； 8-8.1 min， 19%-22%B； 8.1-14 min， 22%-29%B； 14-16 min， 29%B； 16-32 min， 29%-45%B； 32-32.1 min， 45%-90%B； 32.1-35 min， 90%-95%B； 35-36 min， 95%-98%B； 36-37 min， 98%-2%B； 37-40 min， 2%B）. Based on electrospray ionization（ESI）， continuum data format was collected in both positive and negative ion modes with a scanning range of m/z 50-1 500. Chemical constituents in the decoction of Baoyuantang were systematically analyzed by UNIFI 1.9.4 software matching， control comparison， The Encyclopedia of Traditional Chinese Medicine（ETCM） database search and literature reports. ResultA total of 229 components were identified under negative ion mode and 181 under positive ion mode， with a total of 322 components after removing duplicates， including 116 triterpene saponins， 66 flavonoids， 19 organic acids， 6 gingerphenols， 6 gingerols， 5 gingerones， 10 amino acids， 7 saccharides， 5 coumarins and 82 other components. Among them， 83， 141， 39， 35 and 38 components were attributed to Ginseng Radix et Rhizoma， Glycyrrhizae Radix et Rhizoma， Astragali Radix， Cinnamomi Cortex and Zingiberis Rhizoma Recens， respectively. ConclusionIn this study， the rapid characterization and identification of multi-class components in Baoyuantang was realized， and it was confirmed that the material basis of this formula was mainly triterpenoid saponins， flavonoids， gingerols and organic acids， and the chemical composition was attributed and analyzed， which provided a reference for the subsequent quality control research.

ObjectiveBased on ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS）， network pharmacology and molecular docking techniques， to explore the pharmacodynamic material basis and mechanism of Renshen Wuweizi Tang in treating spleen-lung Qi deficiency syndrome. MethodsThe chemical components in the decoction of Renshen Wuweizi Tang were systematically characterized and identified by UPLC-Q-TOF-MS/MS， and network pharmacology was used to screen potential active ingredients， collect component targets and gene sets related to spleen-lung Qi deficiency syndrome， and obtain protein interaction relationships through STRING. Cytoscape 3.9.1 was used to construct a "formula-syndrome" association network and calculate topological feature values. Gene ontology（GO） function and Kyoto Encyclopedia of Genes and Genomes（KEGG） pathway enrichment analysis were performed on core genes to explore potential pharmacodynamic links， the average shortest path between the formula-drug target network and the pharmacodynamic link gene network was calculated to discover dominant pharmacodynamic links， and MCODE plugin was used to identify core gene clusters from the dominant pharmacodynamic links， which were validated using Gene Expression Omnibus（GEO）， and molecular docking was performed between key components and core targets. ResultsOne hundred and thirty-seven components were identified in the negative ion mode， and eighty components were identified in the positive ion mode. After deduplication， a total of 185 components were identified， mainly composed of triterpenoid saponins（49） and flavonoids（54）. Based on the "formula-syndrome" correlation network analysis， energy metabolism was determined to be the dominant pharmacodynamic link of Renshen Wuweizi Tang in the treatment of spleen-lung Qi deficiency syndrome. The results of molecular docking showed that 7 components（adenosine， atractylenolide Ⅱ， atractylenolide Ⅲ， ginsenoside Rg₁， glycyrrhizin B₂， glycyrrhizin E₂ and campesterol） from 4 medicinal materials（Ginseng Radix et Rhizoma， Atractylodis Macrocephalae Rhizoma， Glycyrrhizae Radix et Rhizoma and Poria） in this formula might regulate energy metabolism by acting on 6 targets， namely cyclic adenosine monophosphate-response element binding protein 1（CREB1）， glyceraldehyde-3-phosphate dehydrogenase（GAPDH）， interleukin（IL）-6， nuclear transcription factor（NF）-κB1， peroxisome proliferator-activated receptor α（PPARα）， and tumor necrosis factor（TNF）， thus improving the symptoms of diseases related to spleen-lung Qi deficiency syndrome. ConclusionThis study established a UPLC-Q-TOF-MS/MS for rapid characterization and identification of chemical components in the decoction of Renshen Wuweizi Tang， expanding the understanding of the material composition of this formula， and found that 7 components might act on the key advantageous pharmacodynamic link "energy metabolism" through 6 targets to improve the related symptoms of spleen-lung Qi deficiency syndrome. This can provide a reference for the subsequent exploration of the material benchmark and mechanism of the famous classical formula.