Objective To investigate and evaluate the feasibility and analgesic effect of ultrasound guided intercostobrachial nerve (ICBN) blockade in patients with persistent pain after radical mastectomy with ICBN preservation.Methods In a total of 53 following-up female cases,aged 18-55 years,ASA Ⅰ or Ⅱ,receiving radical mastectomy with ICBN preservation during January,2014 to February,2016,19 patients complained persistent pain in the lateral chest,axilla and/or upper arm more than 3 months after the surgery were enrolled.ICBN blockade was performed using 0.5% ropivacine 10 mL injected in the potential space between the superior of pectoralis minor muscle and the inferior of serratus anterior muscle in the second intercostal space guided by ultrasound.Visual analogue scale (VAS) was applied to assess the pain intensity at rest,on movement,and with 100 kPa pressure before blockage and 30 min thereafter,and then the pain intensity (SPI) was calculated.All nerve blockade-related adverse events including local anesthetic-related allergy,central nervous system and cardiovascular toxicity were recorded.Seven-day follow-ups were required in all patients to assess the pain intensity.Results All 19 cases completed ICBN blockade guided by ultrasound,of which 17 cases completed the seven-day follow-ups.The mean difference in SPI was-9.19 VAS points (95%CI-11.24--7.14,P<0.01).Compared with each mean VAS and SPI before block,all that after block at day 1-6 were significantly decreased (P<0.01 or P<0.05).There were 14(82.4%),13(76.5%),7(41.2%) and 3(17.6%)cases that SPI was decreased over 5 points after block at day 1-4.No nerve blockade-related adverse event was observed.Conclusion Ultrasound guided ICBN blockade can relieve persistent post-mastectomy pain safely and effectively.

ObjectiveTo observe effects of ginkgo bilobate extract injection on the hemorheology,blood lipid and c-reactive protein in serum of patients with cerebral infarction. Methods62 cases patients with cerebral infarction were randomly divided into two groups by means of random number table. Two groups were both given routine treatment. The control group was treated with 20ml compound salvia injection, which was added to 250 ml normal saline, once a day, continuous therapy for 14 days, and the treatment group was treated with 20ml ginkgo bilobate extract injection, which was added to 250 ml normal saline, once a day, continuous therapy for 14 days. The clinical symptoms were observed, hemorheology related index, level of blood lipid and c-reactive protein were detected before and after the treatment. ResultsCompared with the control group,hemorheology related index decreased significantly in the treatment group, especially whole blood viscosity ( 1.57±0.28) mpa ·s (P＜0.01). Blood reduced viscosity (13.95 ± 2.07) mpa ·s, erythrocyte aggregation index (1.37±0.12) , hematocrit (42.36±8.16) were also decreased significantly (P＜0.05) .Triglyceride (TG)(1.23±0.12) mmol/L、 cholesterol (TC) (4.29±1.17) mmtmol/L、 low density lipoprotein cholesterol (LDIL-C)(2.31± 0.39) mmol/L and c-reactive protein ( 10.48 ±- 3.82) mg/L in serum in the treatment group were lower than those of the control group (P＜0.01 orP＜0.05) , high density lipoprotein cholesterol (HDL-C) ( 1.78±0.76) mmol/L in serum was higher than that of the control group (P＜0.01) .The total effective rate of the treatment group and the control group was 87.1％ and 67.7％ respectively, there was a significant difference (x2=3.553, P＜0.05). Conclusion The ginkgo bilobate extract injection can protect cerebral infarction from injury,which may be related with its action on regulating the blood viscosity and level of blood lipid.

Objective To study bacterial conditions in amniotic cavity of the third trimester and the delivery. Methods Patients underwent cesarean section due to various reasons were randomly enrolled in the study. Ten ml aqua amnii taken from using aspesis were cultured and the bacteria were identified and tested for drug sensitivity. All patients were not treated with antibiotics before and during operation,conventional antibiotics treatnent was used after operation. The patients were divided into 3 groups based on their status: 34 cases of premature rupture of membrane ( PROM ), thirty-four cases of labor without PROM, and 27 cases of pregnancy without PROM. The positive rate, species , distribution and drug sensitivity of bacteria in the 3 groups were analyzed. Results The positive rate was 61.8% (21/34) in PROM ,52. 9% ( 18/34 ) in labor without PROM,11.1% (3/27)in pregnancy without PROM. The positive rates were significantly different among the 3 groups (x2 = 17.29 ,P =0.000). However, there was no significant difference between the labor without PROM group and the pregnancy without PROM group ( x2 = 0.541 , P = 0.462 ). Staphylococcus epidermidis was the most common isolated bacteria, following by staphylococcus aureas, streptococcus, colon bacillus, and pseudomonas. There were no significant differences of bacterial species between labor without PROM and pregnancy without PROM( x2 = 11.9,P =0.535 ). The relative higher positive rate in the labor without PROM and PROM indicated that they were important inducement of bacteria infection. There were no significant difference on positive rate and bacteria species distribution between the PROM and labor without PROM group,which suggested that up-bound along vagina to amniotic cavity was the most common route of infection. Sensitive antibiotics should be given to the patients of PROM and labor without PROM targeted at staphylococcus,streptococcus, colon bacillus and monad. Antibiotics such as Cephems, Penicillins and Clindamycin were sensitive to various bacteria and safe to both mother and baby, thus were recommended. Quinupristin, Vancomycin,Furantoin, Fusidic ,Teicoplanin, Amikacin and Meropenem were also sensitive to various bacteria, but due to their side effects and the principle of ladder antibiotics using, they were recommended as second line antibiotics. Conclutions Up-bound along vagina to amniotic cavity is the most common route of infection. For rupture of membrane and labor without PROM patients, antibiotics should be given, and strict aseptic technique,washing cavity and incision, using antibiotics after operation are necessary to prevent infection.

Purpose: Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal malignancy that occurs primarily in children and adolescents. The clinical and pathological features of IMT in adult patients are not well understood. Materials and Methods: We retrospectively searched for records of adult patients with IMT at Fudan University Shanghai Cancer Center from 2006 to 2021. Clinicopathological data, treatments, and outcomes were collected and analyzed. Results: Thirty adult patients with IMT, mostly women (60.0%), were included. The median age of the patients was 38 (21-77). The most common primary site was abdominopelvic region (53.3%), followed by lungs (20.0%). Seven patients had an abdominal epithelioid inflammatory myofibroblast sarcoma (EIMS). The positivity rate of anaplastic lymphoma kinase (ALK) was 81.5% (22/27). Sixteen patients with advanced ALK-positive disease received crizotinib, with an objective response rate (ORR) of 81.3% and a disease control rate of 87.5%. The median progression-free survival was 20.8 months. EIMS was associated with more aggressive behavior; however, the prognosis was similar to that of non-EIMS patients after treatment with an ALK inhibitor. At a median follow-up time of 30 months (95% confidence interval [CI], 13.6 to 46.4), the 5-year overall survival was 77% (95% CI, 66 to 88) in all patients. Conclusion Adult IMTs appeared more aggressive, with a higher incidence of recurrence and metastases, and patients with EIMS had more aggressive cases. Treatment with ALK inhibitors resulted in a high ORR and a durable response, which suggested that ALK inhibitors could be used as a first-line treatment option in adult patients with ALK-positive advanced IMT.

Depression is a kind of complex mental illness， which is mainly treated by western medicine at present， but the effect of western antidepressant drugs is not good due to the combined influence of side effects and individual differences of patients. Depression is a "stagnation syndrome" in traditional Chinese medicine， and its treatment principle is to disperse stagnated liver Qi for relieving Qi stagnation. The classic traditional Chinese medicine formula Chaihu Shugansan （CHSGS） has a long history of treating depression and demonstrates significant therapeutic efficacy. Clinically， the addition and subtraction of CHSGS is flexible， but the properties of the active ingredients are vague， and the mechanism and function are unclear. In order to elucidate the pharmacodynamic basis and antidepressant mechanism of CHSGS， this article reviews the pharmacodynamic material basis of CHSGS， clinical research and antidepressant mechanism research progress. Clinically， CHSGS can treat various types of depression such as primary depression， post-stroke depression， and postpartum depression. This article summarizes 32 main ingredients of CHSGS， among which albiflorin， ferulic acid， naringin， hesperidin， saikosaponin a， glycyrrhetinic acid， tangeretin， meranzin hydrate， nobiletin and glycyrrhizic acid are the quality markers （Q-markers） for the antidepressant effect of CHSGS. The antidepressant mechanism of CHSGS is complex， including regulating monoamine neurotransmitters， hypothalamic-pituitary-adrenal （HPA） axis， neurotrophic factors， inflammatory response， cell damage-related pathways， oxidative stress， etc. This article helps to deeply understand the pharmacodynamic basis and mechanism of CHSGS in treating depression， and provides a theoretical basis for the clinical application of CHSGS in treating depression and the development of antidepressant drugs.

Objective: To explore the effect of hyperbaric oxygen preconditioning with different frequency on the survival rate of flap and ischemia-reperfusion injury in rats after transplantation, and to explore the best preconditioning conditions to improve the survival rate of rat flaps after transplantation. Methods: Thirty-six Sprague Dawley rats were randomly divided into four groups according to the random number table method, 9 groups in each group.Four groups of rats were pretreated with hyperbaric oxygen pretreatment for 0, 2, 4, and 6 days before the operation, control group, pretreatment 2 d group, pretreatment 4 d group, and pretreatment 6 d group. Taking the midline of the back of the rat as the axis, an ultra-long random flap with a pedicle at the tail end and about 1 cm from the superior iliac spine was designed and cut to a size of 10.0 cm×2.5 cm. The survival of the flaps in each group was observed and the final survival area and survival rate of the flaps were measured on the 7th day after surgery. On the 7th day after operation, the tissue was taken at a distance of 5 cm from the pedicle, and the histopathology was observed; The content of superoxide dismutase (SOD) and malondialdehyde (MDA) in flap tissue was detected by immunohistochemistry, and the expression rate of positive cells in each group was calculated. Immunofluorescence was used to detect the expression of interleukin-6 (IL-6) in the flap tissue. Results: On the 7th day after the operation, the survival area and survival rate of the transplanted flaps in the hyperbaric oxygen pretreatment group were significantly higher than those in the control group (P<0.05), and the pretreatment 4 d and 6 d groups were significantly higher than the pretreated 2 d group (P<0.05), but there was no significant difference between the pretreated 4 d group and the 6 d group (P=0.095). Pathological observation on the 7th day after operation showed that there was some necrosis in the control group, the vascular cells in the pretreated 2 d group had more vascular structures, and more neovascularization was observed in the pretreated 4 d group. The inflammatory cells were the least in the 6 d pretreatment group, and the neovascularization was the same as the pretreatment 4 d group. The absorbance A value of SOD in the control group was 0.009 7±0.000 3, and the positive expression rate was 20%, which was significantly lower than that in the hyperbaric oxygen pretreatment group. The difference was statistically significant (P<0.05). However, the absorbance A value of MDA in the control group was 0.055 1±0.003 0, and the positive expression rate was 55%, which was significantly higher than that in the hyperbaric oxygen pretreatment group. The difference was statistically significant (P<0.05). Among them, the SOD absorbance A value of the pretreated 2 d group was 0.023 8±0.003 0, and the positive expression rate was 30%, which was lower than the pretreatment 4 d group (absorbance A value 0.046 9±0.003 0, positive expression rate 35%) and 6 d group (absorbance A value 0.047 2±0.003 6, positive expression rate 40%), The MDA absorbance A value of the pretreated 2 d group was 0.037 2±0.003 2, and the positive expression rate was 30%, which was higher than the pretreatment 4 d group (absorbance A value 0.014 7±0.002 4, positive expression rate 5%) and 6 d group (absorbance A value 0.017 0±0.001 8, positive expression rate 10%), the difference was statistically significant (P<0.05). However, there was no significant difference in the expression of SOD and MDA between the pretreated 4 d group and the pretreated 6 d group (P>0.05). The expression of IL-6 in the hyperbaric oxygen pretreatment group was significantly lower than that in the control group (absorbance A value 44.937 0±0.594 0), the difference was statistically significant (P<0.05). The absorbance A value in the pretreated 2 d group was 41.698 0±0.724 0, which was significantly higher than the pretreatment 4 d group (absorbance A value 34.049 0±0.323 0) and 6 d group (absorbance A value 33.524 0±0.639 0). The difference was statistically significant (P<0.05). There was no significant difference in the expression of the pretreated 4 d group compared with the 6 d group (P=0.068). Conclusions Hyperbaric oxygen preconditioning can significantly promote the survival of rat flaps after transplantation. Preoperative hyperbaric oxygen preconditioning once daily for 4 consecutive days, can enhance the tolerance of flap tissue to ischemia and anoxia and reduce tissue ischemia-reperfusion injury.

Objective : To clarify the distribution of traditional Chinese medicine (TCM) pattern and its associated risk factors after percutaneous coronary intervention (PCI), and evaluate the reporting quality of existing studies to guide future research standardization. Methods: English databases including PubMed, Cochrane Library, and Web of Science, as well as Chinese databases including China National Knowledge Infrastructure (CNKI), China Scientific Journal Database (VIP), and Wanfang Database were searched to retrieve papers about PCI. The time span for the paper retrieval was set from the foundation of the databases to October 1, 2023. Statistical analyses were performed using Stata 12 and Python (V 3.9). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was used to assess the reporting quality of included studies. Result: Overall, 1 356 articles were selected, and 40 cross-sectional studies were included with 10 270 participants. The most common TCM patterns before, one to two weeks after, and six months to one year after PCI was Qi stagnation and blood stasis (n = 261, 36.45%), intertwined phlegm and blood stasis (n = 109, 27.18%), and Qi deficiency and blood stasis (n = 645, 37.03%), respectively. Smoking [odds ratio (OR) = 1.15, 95% confidence interval (CI) (0.83 – 1.47), I 2 = 24.7%, P = 0.257], pattern of congealing cold and Qi stagnation [OR = 4.62, 95% CI (1.37 – 7.86), I 2 = 61.6%, P = 0.074], and low-density lipoprotein (LDL) [OR = 1.38, 95% CI (0.92 – 1.85), I 2 = 12.2%, P = 0.286] were risk factors for restenosis. Hypertension [OR = 7.26, 95% CI (3.54 – 14.88), I 2 = 91.6%, P = 0.001], and overweight [i.e., body mass index (BMI) > 23] [OR = 1.20, 95% CI (1.07 – 1.35), I 2 = 85.3%, P = 0.009] were significant risk factors of concomitant anxiety. Conclusion This systematic review andet a-analysis revealed that patients with different TCM pattern types have distinct characteristics and risk factors after PCI. More high-qualitystudies are warranted to provide supportive evidence for future research and clinical practice.