levels are elevated in patients with NAFL and correlated with HOMA-IR, suggesting RBP4 may participate in the development of IR and NAFL.

Objective To observe the influence of Xin-ke-shu Capsule (XKSC) on NO and ET in patients with coronary artery disease(CAD) combined with type 2 diabetes mellitus(T2DM), and to investigate its mechanism of treatment. Methods 80 patients with CAD combined with T2DM were randomly recruited into two groups: 40 patients in the treatment group were treated by conventional therapy plus XKSC, and the 40 in the control group treated by conventional therapy exclusively. The plasma level of NO and ET was observed before and after the three-month therapeutic course. Results The plasma level of ET in the treatment group significantly decreased after the treatmaent and was lower than that in the control group(P<0.01), but NO in the treatment group elevated significantly and was higher than that in the control group (P<0.01). Conclusion Xin-ke-shu Capsule displays its effect on protecting vascular endothelia by elevating the level of NO and decreasing the plasma level of ET.

Objective To explore a new methodology with bilateral rhomboid dermal flaps for surgical treatment of inverted nipple. Methods 36 cases with 64 inverted nipples were involved in this study. Among these cases, 8 of them were evaluated as mild degree, while 19 moderate and 9 severe. In this procedure, the bilateral rhomboid incisions were designed. The rhomboid skin was deepithelialized and two dermal flaps were created. Then these two dermal flaps were filled crosswise through the tunnel beneath the nipple and fixed as supporting. After the operation, the continuous traction of the nipple lasted for one week, and sutured out 10 days later. Results None of these 36 cases appeared nipple blood circulation disorder after operation. Postoperative follow-up for 6 months-3 years showed that the appearance of the nipple was satisfactory. There were no recurrence and sensory disturbance. Conclusions The method introduced in this study is simple, the appearance of nipple is natural and no complication has been found. The incision is larvaceous while the scar is invisible. Meanwhile this method is also benefit for reserving the function of breast-feeding. It is proved to be an ideal method for correcting the inverted nipple.

ObjectiveTo research the metabolism of components in the Radix of Paeonia lactiflora Pall. Methods(①) we established the HPLC fingerprint of water extract of Paeonia lactiflora Pall. and real-time monitored the chemical composition. (②) We established the HPLC fingerprint of rats' serum samples from hepatic portal vein, serum samples from aorta abdominalis and samples of intestinal absorption of Paeonia lactiflora Pall. (③) On this basis, using the established methods, I-IPLC fingerprint spectrum of serum samples,the sample of herb, the sample after intestinal metabolism, rats' serum samples from hepatic portal vein and rats'serum samples from aorta abdominalis were analyzed and compared in order to infer the metabolism of components in the Radix of Paeonia lactiflora Pall. Results24 compositions were detected, seven of which were metabolized by intestinal flora and could not be absorbed into blood; six of them could not be absorbed directedly into intestinal; eight new compounds were absorbed into blood after bowel metabolism while they were not detected in water extract in Paeonia lactiflora Pall. ConclusionWe could infer the metabolic processes of chemicals of Paeonia lactiflora Pall. in oral administration with this method.

OBJECTIVE To investigate the effect of injection of β2-adrenergic receptor agonist clenbuterol into the infralimbic cortex(IL) on drug-seeking behavior triggered by conditioned cues. METHODS Adult male SD rats were trained to self-administer heroin under a FR1 schedule for consecutive 14 d,followed by 2-h extinction training. Cue-induced heroin seeking was measured for 2 h. Clenbuterol was microinjected bilaterally into the IL(8 ng/side)of rats 15 min prior to reinstatement test. Meanwhile,locomotor activity was detected 15 min after clenbuterol or artifial cerebrospinal fluid(mod?el group) was microinjected bilaterally into IL. Western blotting was used to detect the expression of phosphorylated cyclic AMP response element-binding protein(p-CREB)in the prelimbic cortex(PL), IL,nucleus accumbens core (NACc) and shell (NACsh) of rats immediately after reinstatement test. RESULTS After heroin administration training for 14 consecutive days,these animals exhibited reliable heroin self-administration,indicated by the increase in active nose poke responses and infusions. The rats that had received infusion of clenbuterol into the IL had significantly lower active pokes (8 ± 3)than those in model group(45±10)in cue-induced reinstatement(P<0.01),but there was no significant differ?ence between clenbuterol group and vehicle group in the locomotor activity. The expression of p-CREB in either IL or NACsh was significantly decreased in clenbuterol group compared with model group(P<0.01,P<0.05),but significantly increased in NACc(P<0.01). CONCLUSION Microinjection of clenb?uterol into the IL can attenuate the cue-induced reinstatement of heroin-seeking behavior in rats. The underlying mechanism might be related to the regulation of p-CREB expression in the NACc and NACsh.

Objective:To compare ultrasound (US) guided versus computed tomography (CT) guided radiofrequency ablation (RFA) in treatment of early hepatocellular carcinoma (HCC).Methods:The data of 133 patients with early HCC treated by RFA in the Department of Hepatobiliary Surgery of Shandong Provincial Hospital from February 1, 2015, to January 31, 2017, was analyzed retrospectively. These patients were divided into two groups: the US-guided group and the CT-guided group. The clinical data was collected and the factors affecting prognosis were analyzed.Results:Compared with the CT-guided group, the operation time of the US-guided group was significantly shorter [(29.0±12.0)min vs. (55.0±19.0)min, P<0.05], but the number of ablation sessions per tumor was significantly less [(1.1±0.3) vs. (2.0±0.6), P<0.05]. There was no significant difference in the complete ablation rates, postoperative complication rates and postoperative length of hospital stay between the two groups ( P>0.05). The CT-guided group was superior to the US-guided group in the local tumor recurrence and progression-free survival rates ( P<0.05). On multivariate analysis, CT-guided RFA was an independent protective factor for local tumor recurrence ( HR=0.266, 95% CI: 0.073-0.967, P<0.05) and progression-free survival ( HR=0.415. 95% CI: 0.213-0.806, P<0.05), while AFP >20 ng/ml ( HR=4.821, 95% CI: 1.714-13.560, P<0.05) was an independent risk factor for progression-free survival. Conclusion:CT-guided percutaneous RFA was superior to US-guided RFA in local treatment of early HCC, probably related to more needle placements and longer ablation time under CT guidance.

Objective: To investigate the clinical effect of the reserve-flow anterolateral thigh perforator flap based on aesthetics concept to repair soft tissue defect around the knee joint. Methods: From June 2016 to April 2017, 10 patients with skin and soft tissue defects around the knee joint were admitted to Mingzhou Hospital of Zhejiang University. The area of the soft tissue defects around the ankle were ranged from 5.0 cm × 3.0 cm to 11.0 cm × 7.5 cm after debridement. The anterolateral thigh perforator flaps were designed on the ipsilateral lateral thigh, according to the results of preoperative perforator detection. The reserve-flow anterolateral thigh perforator flaps based on aesthetic concept were used to repair the wound through the subcutaneous tunnel. The flaps were 5.5 cm × 3.5 cm to 12.0 cm × 8.0 cm in size. The donor sites were directly closed. Results: The flaps of 9 patients completely survived, however, epidermal necrosis occurred to 1 patient, at the distal end of the flap, about 1 cm × 1 cm in size. It completely healed after dressing change for 1 week. The follow up time was from 8 to 15 months (mean 12 months). The flaps were satisfactory in appearance, good in the elasticity, nearly normal in color, and had protective sensation. The two-point discrimination perception ranged from 9 to 13 mm(mean 10 mm). The donor and recipient sites only remained linear scars, with no depression deformity. The lower limb functions were normal. Conclusions The reverse-flow anterolateral thigh flap based on aesthetic concept, is an alternative method to repair the soft tissue defect around the knee joint, and protect the donor site to the maximum extent.

Objective:To investigate the types, incidences, and clinical characteristics of shock in polytrauma patients at different stages after polytrauma.Methods:A retrospective study was conducted on polytrauma patients admitted to multiple trauma centers from June 2020 to December 2021. The inclusion criteria were patients >18 years old and treated due to polytrauma. Exclusion criteria included an admission time of more than 48 h after trauma, a history of malignancy, or metabolic, consumptive, and immunological diseases. The early stage was defined as the period of ≤48 h after polytrauma, and the middle stage was defined as the period between 48 h and 14 days. The patient’s medical history, clinical manifestations, laboratory tests, imaging examination, injury severity score (ISS), and Glasgow coma scale (GCS) were collected. The types, incidences, and clinical characteristics of shock in different stages after polytrauma were analyzed, according to the diagnostic criteria of each type of shock. The differences between the groups were compared by Student’s t test, χ2 test or Mann-Whitney U test. Results:The incidence of the early and middle stage shock after polytrauma were 73.1% and 36.4%, respectively, with statistically significant difference between stages ( P<0.01). There were significant differences in the incidence of hypovolemic shock (83.6% vs. 28.4%), distributed shock (13.7% vs. 80.9%) and cardiogenic shock (3.5% vs. 6.6%) between stages (all P<0.05). The incidence of obstructive shock (8.4% vs. 9.7%, P>0.05) was similar between stages. The incidence of undifferentiated shock was 1.6% and 1.2%, respectively. There were 9.5% patients with multifactorial shock in the early stage and 14.4% in the middle stage. Totally 7 combinations of multifactorial shock were found in different stages after polytrauma. In the early stage, the combination of HS and DS accounted the highest ratio (42.3%) and followed by HS and OS for 28.8%. In the middle stage, the combination of HS and DS was the most common (48.6%) and followed by DS and OS (24.3%). Conclusions:The incidence of shock in polytrauma patients is high. Different types of shock can occur simultaneously or sequentially. Therefore a comprehensive resuscitation strategy is significant to improve the success rate of treatment.

Objective To analyze TCM master Yan Zhenghua's medication rules of ascending,descending,floating and sinking properties for the treatment of respiratory diseases,inherit his valuable academic experience.Methods Using four books edited by Professor Yan Zhenghua's disciples as the main source,Professor Yan Zhenghua's prescriptions for clinical treatment of respiratory diseases were systematically collected and analyzed.Statistical analysis was conducted on the patients'gender and age,differentiation of diseases and syndrome types of the prescriptions,as well as the properties of ascending,descending,floating and sinking,dosage,and commonly used pairs of Chinese materia medica.Results Totally 208 prescriptions were included in this study,involving 178 kinds of Chinese materia medica and 64 kinds of monarch drug,most of them were descending and sinking drug,and the whole prescription was mainly descending and sinking.On average,each prescription used 13.2 kinds of Chinese materia medica,and most dosage points were within the range of conventional dosage.Among later adding medicines,Houttuyniae Herba had the highest frequency of use.The medicinal pairs of Asteris Radix et Rhizoma-Cynanchi Stauntonii Rhizoma et Radix,Cynanchi Stauntonii Rhizoma et Radix-Stemonae Radix and Asteris Radix et Rhizoma-Stemonae Radix were often used.Armeniacae Semen Amarum,Fritillariae Thunbergii Bulbus,and Asteris Radix et Rhizoma were commonly used in those descending and sinking prescriptions.Conclusion In the treatment of respiratory diseases,Professor Yan Zhenghua prefers to use descending and sinking drugs with ascending and floating drugs and dual trend drugs to regulate qi activity,and has the characteristics of Menghe medical school,which is"mild and flexible medication".