ObjectiveTo investigate the mechanism of action of modified Shaofu Zhuyutang in antagonizing cellular pyroptosis and fibrosis in ectopic endometrial tissues of endometriosis through the Toll-like receptor 4/nuclear factor-κB/NOD-like receptor protein 3 （TRL4/NF-κB/NLPR3） signaling pathway. MethodsSeventy-two SPF-grade female SD rats were randomly divided into a sham-operated group （n = 12） and a modeling group （n = 60）. The rats in the sham-operated group underwent a caesarean section， while the rats in the modeling group were used to establish an endometriosis model through the auto-transplantation method. After successful modeling， the animals were randomly divided into the model group， progesterone group （0.25 mg·kg^-1）， and modified Shaofu Zhuyutang low-， medium-， and high-dose groups （7.5， 15， 30 g·kg^-1）， with 12 animals in each group. After 4 weeks of drug administration， voluntary activity and heat pain latency were observed. The rats were sacrificed for tissue collection， and Masson staining were used to observe histopathological changes in the endometrial tissues. Enzyme-linked immunosorbent assay （ELISA） was used to measure serum levels of interleukin-18 （IL-18）， interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， and transforming growth factor-β （TGF-β）. Immunohistochemistry （IHC） was used to detect the protein expression area of tumor necrosis factor-related factor 6 （TRAF6） and NLPR3 in the endometrial tissues. Immunofluorescence （IF） was used to detect the relative fluorescence intensity of Caspase-1 and gasdermin D （GSDMD） in the endometrial tissues. Western blot was employed to measure the relative expression of TRL4， myeloid differentiation factor 88 （MyD88）， TRAF6， NF-κB p65， phosphorylated NF-κB p65 （p-NF-κB p65）， and NLPR3 proteins in endometrial tissues. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression of TRL4， MyD88， TRAF6， NF-κB， and NLPR3 in the endometrial tissues. ResultsCompared with the sham-operated group， rats in the model group showed reduced voluntary activity and shorter heat pain latency. Serum levels of IL-18， IL-1β， TNF-α， and TGF-β were elevated. The relative expression areas of TRAF6 and NLPR3 proteins were increased， and the relative fluorescence intensity of Caspase-1 and GSDMD was enhanced. The relative expression of TRL4， MyD88， TRAF6， NF-κB p65， p-NF-κB p65， and NLPR3 proteins， along with the expression of TRL4， MyD88， TRAF6， NF-κB， and NLPR3 mRNA， were significantly increased （P<0.01）. Compared with the model group， rats in the progesterone group and the modified Shaofu Zhuyutang medium- and high-dose groups exhibited improved voluntary activity， longer heat pain latency， the fibrosis of endometrial tissue is alleviated. Serum levels of IL-18， IL-1β， TNF-α， and TGF-β were decreased. The relative expression areas of TRAF6 and NLPR3 proteins decreased， and the relative fluorescence intensity of Caspase-1 and GSDMD weakened. The relative expression of TRL4， MyD88， TRAF6， p-NF-κB p65， NLPR3 proteins， and TRL4， MyD88， TRAF6， NF-κB， and NLPR3 mRNA expression were reduced （P<0.05， P<0.01）. ConclusionModified Shaofu Zhuyutang may play a therapeutic role in endometriosis by interfering with key proteins in the TRL4/NF-κB/NLPR3 signaling pathway， reducing NLRP3 inflammasome-induced cellular pyroptosis， antagonizing the fibrosis process in ectopic endometrial tissues， improving the inflammatory microenvironment in the pelvic cavity， and alleviating pain.

ObjectiveTo observe the effects of modified Shaofu Zhuyutang on key proteins of the epidermal growth factor receptor （EGFR）/phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway in SD rats with endometriosis. MethodsAfter successful establishment of an endometriosis model in 60 female SD rats of SPF grade via the auto-transplantation method， the rats were randomly divided into a model group， modified Shaofu Zhuyutang high-， medium-， and low-dose groups， and a gestrinone group， with another 12 rats serving as a blank group. The blank and model groups were administered 10 mL·kg^-1 normal saline， while the high-， medium-， and low-dose groups received 30， 15， and 7.5 g·kg^-1 modified Shaofu Zhuyutang， respectively. The gestrinone group was administered 0.25 mg·kg^-1 gestrinone suspension. After four weeks of treatment， uterine contractions were induced with 2 U of oxytocin， and the writhing response of rats was observed. After 24 h， the rats were euthanized， and the weight and volume of ectopic endometrial tissue were recorded. Hematoxylin-eosin （HE） staining was used to observe pathological changes in endometrial tissues， while the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling （TUNEL） assay was used to evaluate the apoptosis rate of endometrial tissues. Immunofluorescence was used to detect the relative expression areas of the B-cell lymphoma-2 gene-associated promoter （Bad） and B-cell lymphoma-2 （Bcl-2） proteins in endometrial tissues. Serum levels of interleukin-1β （IL-1β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， epidermal growth factor （EGF）， and EGFR were measured by enzyme-linked immunosorbent assay （ELISA）. The relative protein expression levels of EGFR， PI3K， phosphorylated PI3K （p-PI3K）， Akt， and phosphorylated Akt （p-Akt） in endometrial tissues were analyzed by Western blot. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression levels of EGFR， PI3K， and Akt. ResultsCompared with the blank group， the model group showed endometrial thickening， glandular and mesenchymal hyperplasia， a significant decrease in the relative expression area of Bad in ectopic endometrial tissues， a significant increase in the relative expression area of Bcl-2， and a significant reduction in the apoptosis rate as indicated by TUNEL staining. Serum levels of IL-1β， IL-6， TNF-α， EGF， and EGFR were significantly elevated （P<0.01）. The relative protein expression levels of EGFR， PI3K， p-PI3K， Akt， and p-Akt， as well as the mRNA expression levels of EGFR， PI3K， and Akt， were also significantly increased （P<0.01）. Compared with the model group， the high- and medium-dose groups of modified Shaofu Zhuyutang and the gestrinone group exhibited reduced glandular and mesenchymal hyperplasia to varying degrees， with dilated glandular lumens. The number of writhing responses was significantly reduced， the latency to writhing response was significantly prolonged， and the weight and volume of ectopic endometrial tissue were significantly decreased. The relative expression area of Bad in ectopic endometrial tissue was significantly increased， the relative expression area of Bcl-2 was significantly decreased， and the apoptosis rate was significantly elevated as shown by TUNEL staining. Serum levels of IL-1β， IL-6， TNF-α， EGF， and EGFR were significantly reduced， and the relative protein expression levels of EGFR， PI3K， p-PI3K， Akt， and p-Akt， as well as the mRNA expression levels of EGFR， PI3K， and Akt， were significantly decreased （P<0.05，P<0.01）. ConclusionModified Shaofu Zhuyutang may exert therapeutic effects on endometriosis by interfering with key proteins of the EGFR/PI3K/Akt signaling pathway and inducing apoptosis in ectopic endometrial tissue.

Objective To observe the clinical manifestations of 3 cases with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis antibody overlapping syndrome (MNOS), aiming to expand the understanding of the clinical spectrum of such syndromes. Methods Retrospective analysis was performed on the data of 3 patients with MNOS who were positive for both MOG antibodies and NMDAR antibodies. Clinical features, neuroimaging characteristics, and outcomes were collected, and cell-based assay (CBA) technique was used for diagnosis. Results One case presented both positive MOG antibodies and NMDAR antibodies, but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis. In one case, the clinical and cranial magnetic resonance imaging (MRI) features of demyelinating disease recurred after anti-NMDAR encephalitis, with atypical symptoms of MNOS such as numbness and weakness in limbs, blurred vision, and diplopia. The last case presented both positive MOG antibodies and NMDAR antibodies, but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis. In MNOS, MOG antibody-associated disease and anti-NMDAR encephalitis may appear simultaneously or sequentially, with epilepsy being the most common symptom. Cranial MRI findings showed that the patients presented and mainly involved supratentorial lesions, which may also involve the brainstem, but no spinal cord lesions were found. All patients showed slightly abnormal cerebrospinal fluid. Patients showed a good response to first-line immunotherapy during the acute phase of the disease, with a favorable prognosis. But most patients were prone to relapse. Conclusion In MNOS patients, anti-NMDAR encephalitis may present with clinical and(or)MRI features of demyelinating disease simultaneously or sequentially. The clinical manifestations of patients are complex and diverse. Patients with atypical symptoms require to improving the understanding of MNOS and timely treatment.

Objective To observe the application effect of magnetic resonance imaging technology in evaluating the brain structure and function of patients with type 2 diabetic painful neuropathy (PDN). Methods Forty patients with type 2 diabetes mellitus hospitalized in our hospital were selected as the study objects, and were divided into diabetes mellitus (DM) group (n=12), peripheral neuropathy (DPN) group (n=14) and PDN group (n=14). General clinical biochemical indexes of three groups were analyzed. The structural brain and function of brain area in three groups were compared. Results Age, duration of diabetes, systolic blood pressure, diastolic blood pressure, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), free fatty acid (FFA), albumin (ALB), creatinine (Cr), uric acid (UA), estimated glomerular filtration rate (eGFR), cystatin C (Cys-C), total cholesterol (TC), triglyceride (TG) of the three groups were compared, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TGAb), thyroid peroxidase antibody (TPO-Ab) and serum calcium (Ca) in the three groups showed no significant differences (P > 0.05). Compared with the DM group, the gray matter volume (GMV) in the DPN group was significantly decreased (P < 0.05). Compared with the DM group, amplitude of low frequency fluctuation (ALFF) and fractional amplitude of low frequency fluctuation (fALFF) of left medial superiorfrontal gyrus in the PDN group were significantly decreased (P < 0.05). Conclusion Abnormal GMV in the left angular gyrus in DPN patients may be associated with a higher risk of concomitant cognitive impairment. The decrease of ALFF in the right cerebellar vermis and fALFF in the left medial superior frontal gyrus in PDN patients may be related to the pathogenesis of pain.

Objective : To explore the association of time in range(TIR) and glucose management indicator ( GMI) with the risk of type 2 diabetic nephropathy (DN) ． Methods : The clinical data of 215 patients with type 2 diabetes mellitus (T2DM) were collected and analyzed．According to the results of estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio( UACR) ，they were divided into 117 patients with T2DM and 98 patients with DN．The clinical data，biochemical indicators and continuous glucose monitoring ( CGM) indicators of the two groups were compared．Logistic regression was used to analyze the influencing factors of DN risk．The predictive value of TIR and GMI on the risk of DN was evaluated by receiver operating characteristic (ROC) curve. Results: There were significant differences in age，duration of diabetes，systolic blood pressure，glycosylated hemoglobin ( HbA1c) ，fasting plasma glucose (FPG) ，2 hour postprandial plasma glucose (2hPG) ，creatinine( Cr) ，UACR, eGFR between the two groups(P＜0. 05) ．There were statistically significant differences between the two groups in the CGM indexes of GMI，mean absolute difference of mean of daily differences ( MODD) ，glucose above target range time(TAR) and TIR(P＜0. 05) ．The results of logistic regression analysis showed that TIR was a protective factor of DN．In the ROC curve analysis of TIR prediction DN，the area under the ROC curve was 0. 718 (95% CI = 0. 648 ～0. 789，P＜0. 001) ，and the Yoden index was 0. 38．At this time，the sensitivity was 66. 7% ，and the specificity was 71. 3%．In the ROC curve analysis of GMI prediction DN，the area under the ROC curve was 0. 701 (95% CI = 0. 629 ～0. 774，P＜0. 001) ，and the Yoden index was 0. 368．At this time，the sensitivity was 63. 3% ， and the specificity was 73. 5%． Conclusion Specifically，lower TIR and higher GMI increase the risk of DN.

Objective:To develop a single-tube one-step multiplex nested real-time reverse transcription polymerase chain reaction (RT-PCR) assay for the simultaneous detection of 2019-nCoV, influenza A virus, influenza B virus and internal-control with human-derived gene.Methods:This study included 30 positive specimens for 2019-nCoV nucleic acid detection and 336 screening specimens collected from the arrivals at Guangzhou Baiyun Airport between February 2020 and February 2022. Sixty-four positive specimens of other respiratory pathogens were also collected from the arrivals at Guangzhou Baiyun Airport during the three-year period before the occurrence of COVID19 outbreak in 2020, and 7 positive viral strains of respiratory pathogens were provided by collaborative laboratories. In order to establish a set of multiplex nested real-time RT-PCR assay, a group of primers and probe combinations for a multiplex nested real-time RT-PCR was designed and screened according to a selection of nucleotide conserved regions of the ORF and N genes of 2019-nCoV and the M gene of influenza A and B viruses, while nested amplification primers and probe for the internal-control with human-derived gene were introduced. Then the prepared pseudovirus-positive quality control and sample discs were applied to evaluate the sensitivity and specificity. Clinical specimens were performed to validate the applicability of the method.Results:The results show that the established one-step multiplex nested real-time RT-PCR assay can specifically detect 2019-nCoV and influenza A and B viruses, with the limit-of-detection of about 125 copies/ml for 2019-nCoV and about 250 copies/ml for influenza A and B viruses. Totally 101 positive samples of various respiratory pathogens were detected, showing that the detection sensitivities of 2019-nCoV and influenza A and B viruses were 96.67%, 92.86% and 96.15%, respectively, with the specificity of 100%. No false-positive detection was found in the applied detection of more than 300 clinical samples.Conclusions:A one-step multiplex nested real-time RT-PCR assay for 2019-nCoV, influenza A and B viruses and human-derived gene internal-control was developed. The assay has good sensitivity and specificity and can be used for rapid screening of 2019-nCoV and influenza A and B viruses in high-volume samples.

Objective:To explore the effect of colonoscopy combined with X-ray stent implantation in the treatment of colorectal cancer intestinal obstruction, and analyze the risk factors of postoperative delayed bleeding.Methods:From November 2016 to December 2020, 382 patients with colorectal cancer intestinal obstruction in Hainan Provincial People′s Hospital were selected. Among them, 254 patients were treated by colonoscopy combined with X-ray stent implantation (stent implantation group), and 128 patients were treated by emergency radical resection (control group). The operation time, intraoperative bleeding, number of lymph node dissections, tumor diameter, incision length, exhaust time, hospital stay, fluid feeding time, fistulation, perioperative death and delayed bleeding were compared between 2 groups. Based on the random number generated by the computer, 254 patients who underwent colonoscopy combined with X-ray stent implantation were divided into training set (190 cases) and test set (64 cases) according to the ratio of 3∶1. In the training set, the patients were divided into postoperative delayed bleeding and non postoperative delayed bleeding, and the clinical indicators were compared; the multivariate Logistic regression model was performed to analyze the independent risk factors of postoperative delayed bleeding, and the prediction model of postoperative delayed bleeding was established and verified according to the independent risk factors.Results:All patients in the stent implantation group were successfully implanted with stents, and the obstructive symptoms were relieved 24 to 48 h after operation. The operation time, intraoperative bleeding, incision length, fistulation rate, exhaust time, hospital stay and fluid feeding time in stent implantation group were significantly lower than those in control group: (88.89 ± 5.97) min vs. (116.58 ± 20.17) min, (33.18 ± 16.52) ml vs. (92.35 ± 25.64) ml, (4.50 ± 0.96) cm vs. (14.26 ± 2.88) cm, 10.24% (26/254) vs. 98.44% (126/128), (1.18 ± 0.58) d vs. (1.53 ± 0.77) d, (7.69 ± 5.12) d vs. (12.88 ± 6.54) d and (1.46 ± 0.68) d vs. (2.12 ± 1.18) d, the number of lymph node dissections was significantly higher than that in control group: (19.88 ± 4.47) lymph nodes vs. (17.47 ± 3.11) lymph nodes, and there were statistical differences ( P<0.01); there were no statistical differences in tumor diameter and perioperative fatality rate between 2 groups ( P>0.05). Among 190 patients in the training set, 18 patients had postoperative delayed bleeding, with an incidence of 9.47%; 172 cases did not have postoperative delayed bleeding. The age, course of obstruction, complete obstruction rate, intestinal almost occlusion rate under enteroscopy, intraoperative bleeding rate and preoperative intestinal surgery history rate in patients with postoperative delayed bleeding were significantly higher than patients without postoperative delayed bleeding: (69.52 ± 10.54) years old vs. (58.65 ± 15.87) years old, (14.56 ± 10.12) d vs. (8.13 ± 7.68) d, 11/18 vs. 20.35% (35/172), 11/18 vs. 16.28% (28/172), 7/18 vs. 11.63% (20/172) and 12/18 vs. 37.79% (65/172), and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistics regression analysis result showed that old age, long duration of obstruction, complete obstruction, almost intestinal obstruction under enteroscopy and intraoperative bleeding were independent risk factors for postoperative delayed bleeding in patients with colorectal cancer intestinal obstruction undergoing colonoscopy combined with X-ray stent implantation ( OR = 3.925, 4.802, 1.727, 2.710 and 2.581; 95% CI 1.352 to 8.330, 1.064 to 8.869, 1.063 to 2.804, 1.118 to 4.400 and 1.689 to 3.479; P<0.05 or<0.01), while the history of preoperative intestinal surgery was not related to postoperative delayed bleeding ( P>0.05). The consistency indexes of nomogram training set and test set were 0.742 and 0.726 (95% CI 0.684 to 0.845 and 0.640 to 0.812). The receiver operating characteristic (ROC) curve analysis results of 2 models showed that the area under the curve (AUC) of the training set nomogram model and Tree Augmented Na?ve Bayes (TAN) model was 0.758 and 0.752 respectively, and the AUC of the test set nomogram model and TAN model was 0.702 and 0.706 respectively. The prediction accuracy of training set nomogram model and TAN model was 84.74%(161/190) and 85.26%(162/190) respectively, the prediction accuracy of test set nomogram model and TAN model was 82.81%(53/64) and 84.38%(54/64) respectively. Conclusions:Colonoscopy combined with X-ray stent implantation is safe and feasible in patients with colorectal cancer intestinal obstruction. But for the old age, long duration of obstruction, complete obstruction, almost intestinal obstruction under colonoscopy and intraoperative bleeding, careful operation should be carried out to reduce the occurrence of postoperative delayed bleeding.

OBJECTIVE: To explore the protective effect of electroacupuncture against acute lung injury (ALI) in septic rats and explore the mechanism. METHODS: Sixty male SD rats were randomly divided into cecal ligation and puncture (CLP)-induced sepsis group ( RESULTS: Compared with those in the sham operation group, the rats in ALI group showed obvious lung pathologies with significantly increased lung W/D ratio ( CONCLUSIONS Electroacupuncture can inhibit the release of inflammatory mediators and cell apoptosis via the JAK1/STAT3 pathway to reduce lung injuries in septic rats.
Acute Lung Injury/therapy* ; Animals ; Electroacupuncture ; Lung ; Male ; Rats ; Rats, Sprague-Dawley ; Sepsis/therapy* ; Tumor Necrosis Factor-alpha

Objective: To investigate the successful signs of laser photocoagulation or endolaser combined vitrectomy for congenital optic disc pit (ODP) with serous macular detachment. Methods: A retrospective case analysis. Twelve eyes of 12 patients with congenital ODP complicated with serous macular detachment diagnosed in Zhongshan Ophthalmic Center from 2003 to 2018 were included in this study. There were 2 males (2 eyes) and 8 females (8 eyes). The average age was 30.17 years old. Retinal laser photocoagulation and/or vitrectomy were performed in all the eyes. The optic disc and macular area were scanned using the tracking mode of the Germany Heidelberg Spectralis OCT instrument. The "dam-sign" change was a retinal choroidal scar on the channel between the ODP and the macula on the OCT image after treatment. The eyes were divided into a "dam-sign" change group (group A, 10 eyes) and no "dam-sign" change group (group B, 2 eyes). The BCVA of eyes in group A was 0.03-0.6. In group A, 1 eye was treated with laser photocoagulation alone, 9 eyes were treated with vitrectomy combined with laser photocoagulation. The BCVA of eyes in group B was 0.1. All the eyes in group B underwent vitrectomy combined with laser photocoagulation. The follow-up was ranged from 6 to 174 months. The same equipment and method before treatment were used for 1, 3, 6, 12, 18, and 24 months after treatment. The BCVA, absorption of subretinal fluid (SRF) and the formation of "dam-sign" change were observed. Results: At the last follow-up, the BCVA of eyes in group A was 0.4-1.0 (0.4 in 1 eye, 0.5 in 3 eyes, 0.6 in 2 eyes, 0.8 in 3 eyes, 1.0 in 1 eye). In 9 eyes treated with vitrectomy combined with laser photocoagulation, SRF was completely absorbed. In 1 eye treated with laser photocoagulation alone, SRF remained in small amount. The BCVA of the two eyes in group B was 0.03 and 0.3, respectively; and SRF was not absorbed in both of them. Conclusions The "dam-sign" change near optic disc after laser photocoagulation can promote SRF absorption and improve BCVA. It can be used as a success indicator after treatment.

Objective There is no quantization scheme for the early ambulation in patients with gastrointestinal tumor after operation of enhanced recovery .The aim of this study was to explore a suitable objective method of postoperative ambulation for gastro -intestinal tumor patients . Methods Sixty six gastrointestinal tumor postoperative patients were randomly assigned to two groups :ex-perimental group ( 33 cases ) and control group ( 33 cases ) .Enhanced recovery was adopted in the both groups afterthe operation . Wireless smart bracelets ( fitbit flex) were used in the experimental group , and the ambulation of patients was monitored by the hand of synchronous real time computer digital panel .At the same time, the patients was supervised for positive ambulation . Traditional quantitative methods of electronic pedometer were used in the control group.The postoperative ambulation , effect and compliance were compared between the two groups . Results Postoperative ambula-tion steps in the experimental group were increased compared with the control group on the days 1, 2, and 3postoperative, and the data were (208.70 ±45.76) vs (144.36 ±47.68), (560.73 ±148.67) vs (407.00 ±85.92), and (894.70 ±91.68) vs (674.00 ±73.06) steps (P<0.05).The first time of early ambulation, flatus, ca-tharsis, and compliance of ambulation showed significant difference in the two groups (P<0.05). Conclusion Wireless intelligent monitoring bracelet is objective and effective for monitoring and quantifying postoperative ambulation .It is superior to the traditional quantitative methods , and can improve the effect and compliance of the ambulation .Moreover , it can promote postoperative recovery in patient with enhanced recovery surgery .