Objective To observe the effect of Weipixiao, a compound recipe which has the actions of strengthening spleen, resolving stasis and removing toxins, on the histopathological changes of gastric mucosal tissue in rats with gastric precancerous lesions ( GPL) . Methods SD rats were randomly divided into normal group, model group, Vitacoenzyme group (0.2 g·kg-1·d-1), and high-, middle-, and low-dose Weipixiao groups ( in the dose of 15, 7.5, 3.75 g·kg-1·d-1, respectively) . Except for the normal control group, the rats in other groups received spontaneous intake of N-methyl-N’-nitro-nitrosoguanidine ( MNNG) solution combined with irregular diet and oral use of purgative herbs for 18 weeks to induce GPL. From the 9th week, the mediation groups were simultaneously given corresponding medicine for 10 weeks. At the end of the experiment, the histopathological changes of gastric mucosal tissue in all groups were observed. Results Pathological scores of intestinal metaplasia and epithelial dysplasia in rat gastric mucosa of the model group were significantly increased ( P<0.01 compared with those of the normal group) , but were decreased in three Weipixiao groups to various degrees, particularly in low-dose Weipixiao group ( P<0.05 or P<0.01) . Conclusion Weipixiao can block and reverse gastric intestinal metaplasia and dysplasia in GPL rats to certain degrees, and low-dose Weipixiao may have better long-term effect for the prevention and treatment of GPL.

[Objective]To sort out the connotation,pathogenesis and treatment of"wind injuring the heart"in ancient literature,in order to provide theoretical reference for the treatment of refractory diseases such as viral myocarditis and epilepsy.[Methods]Based on the database of the fifth edition of the Chinese Medical Code,this study examines the discourse on"wind injuring the heart"in ancient literature,analyzes the specific connotation of"wind injuring the heart"from three perspectives:"the connotation of the heart""the pronunciation of Zhong"and"the connotation of wind",and summarizes its clinical symptoms,pathogenesis and treatment,in order to better guide clinical practice.[Results]The"heart"in traditional Chinese medicine is the master of the viscera.It not only has the function of controlling blood vessels,but also has the ability to store spirits.At the same time,some ancient physicians often used"heart"to refer to the spleen and stomach in the middle-Jiao.The"wind"in traditional Chinese medicine includes external wind and internal wind.The internal wind is often generated by emotion.Therefore,based on the relevant discussion of ancient and modern literature,the paper briefly expounds the different connotations of"wind injuring the heart",including wind damage to the heart of flesh and blood,wind damage to the heart of the spirit and other types of wind injuring the heart.Wind damage to the heart of flesh and blood and other types of wind injury to the heart are mostly caused by external wind,and wind damaging the heart of the spirit can be caused by external wind or internal wind.The treatment of wind damage to the heart of flesh and blood is mainly composed of drugs for dispelling wind,supplemented by drugs for reinforcing Qi and nourishing blood;wind damaging the heart of the spirit is mainly calming.[Conclusion]Wind damage to the heart of flesh and blood,wind damaging the heart of the spirit and other types of wind injury to the heart are very similar to the viral myocarditis,nervous system diseases,and gastrointestinal diseases in modern medicine,or the clinical prescriptions for these three kinds of diseases can be provided with theoretical basis according to ancient literature.

The present study was aimed to use the 3-D cone beam CT (CBCT) as a new method in human bite marks identification which was carried out in experimental pigskin to assess its effectiveness in our laboratory. Bite marks were digital photographed according to American Board of Forensic Odontology (ABFO) guidelines. In this study, the data of the suspect's dental casts were collected by scanning in two ways: one was after plate scanning, in which the comparison overlays were generated by Adobe Photoshop 8.0 software; the other was by CBCT, which generated comparison overlays automatically. The bite marks were blind identified with the two kinds of data of the suspect's dental casts respectively. ROC curve was used to analyze the sensitivity, specificity, and 95% confidence interval. The results showed that CBCT method got a larger area under the ROC curve: 0.784 (SE = 0.074, 95% CI = 0.639-0.929), and got a very high specificity (specificity 98.7%, 95% CI = 94.5%-99.8%). Thus, this study illustrates that the CBCT used in bite mark identification is an effective and accurate tool and has stronger ability to exclude suspects compared with the conventional method, but the comparison process needs further study to enhance its effectiveness in bite mark identification.
Adolescent ; Adult ; Bites, Human ; diagnostic imaging ; Cone-Beam Computed Tomography ; methods ; Copying Processes ; Dental Models ; Dentition ; Female ; Forensic Dentistry ; methods ; Humans ; Imaging, Three-Dimensional ; methods ; Male ; Radiographic Image Interpretation, Computer-Assisted ; methods ; Young Adult

Objective To establish the continuing nursing model for ventilator-dependent children in China and explore its feasibility.Methods Ventilator-dependent children in our hospital from October 2015 to February 2017 were recruited.Self-designed home ventilation follow-up card and long-term ventilator-dependent children outpatient follow-up card were used to collect information.We established files for patients trained and evaluated caregivers conducted discharge assessment for patients and family status performed follow-up and management.Results Totally 30 cases of parents and caregivers received home care training and passed the examination 15 cases of ventilator-dependent children returned home with home ventilator and 12 received follow-up.The total readmission rate was 58.3％;among them the readmission rate in one month was 33.3％.One case died due to deteriorated primary disease and 11 cases used home mechanical ventilation successfully during follow-up.The length of home mechanical ventilation varied from 5 months to 2 years.Conclusion The continuing nursing model for ventilator-dependent children is feasible.

Children with prolonged mechanical ventilation often have complex conditions, such as long hospital stay of PICU.They have many complications and high mortality.In addition, these patients have low quality of life, lack of psychological care, family emotional communication, and heavy burden of disease.The long-term management and rehabilitation of these children should be strengthened.This study summarized the researches of prolonged mechanical ventilation in adults at home and abroad, in order to provide experience for prolonged mechanical ventilation management in children.

Objective To analyze the clinical effects of procedure for prolapse and hemorrhoids combined with external hemorrhoidectomy in the treatment of mixed hemorrhoid. Methods Clinical data of 108 patients with mix hemorrhoid who were admitted to our hospital from January 2012 to January 2014 were retrospectively analyzed. The 108 patients were assigned to an observation group and a control group according to the surgical procedures. 54 patients in the ob-servation group received procedure for prolapse and hemorrhoids combined with external hemorrhoidectomy, and 54 pa-tients in the control group received the conventional Milligan-Morgan operation. Each clinical index, pain conditions within 3 days after surgery and complications within 6 months after the surgery in the two groups were compared. Re-sults Surgery time, amount of bleeding during surgery, hospitalization time, and hospitalization expenses in the observa-tion group were all significantly better than those in the control group, and the differences were statistically significant (P<0.05). Pain scores in 24 h, 48 h, and 72 h after the surgery in the observation group were significantly lower than those in the control group, and the differences were statistically significant (P<0.05). In 24 h, 48 h and 72 h after the surgery, patients in the observation group had suffered less pain than those in the control group. Except for one of the patients who had complications before the surgery, total incidence of complications within 6 months after the surgery in the observation group was 18.51%, significantly lower than that of 81.50% in the control group, and the difference was statistically significant(P<0.05). Conclusion The procedure for prolapse and hemorrhoids combined with external hemor-rhoidectomy in the treatment of mix hemorrhoid has favorable effects of lower pain degree and less incidence of com-plications, and the combined procedure is suitable to be further promoted and applied clinically.

The dysfunction of qi, blood, and fluid underlies the pathology of diabetes mellitus. The symptoms, signs, and physical and chemical indexes of diabetes mellitus patients reflect the duration, degree, primary and secondary pathological state of the abnormal metabolism of qi, blood, and fluid. It is necessary to construct a three-dimensional syndrome differentiation system of diabetes mellitus based on spatial and temporal dimensions. According to the four stages of depression, heat, deficiency, and damage, the location of the disease can be locked into qi, ying, and blood levels. The process reflects the pathological trend of the abnormal metabolism of qi, blood, and fluid: qi depression (prodromal stage: asymptomatic metabolic disorder/early stage of qi level) → qi heat (initial stage: index stage/late stage of qi level) → deficiency of both qi and yin (middle stage: symptom stage of three more and one less/stage of ying level) → damage of zang-fu viscera and meridians (late stage: complication stage/stage of blood level). According to the time process, the treatment principles are proposed as follows: during the early stage of qi level, treatment should focus on strengthening the spleen to regulate qi flow, to prevent the accumulation of glucose; during the late stage of qi level, treatment should focus on clearing heat and resolving turbidity, to remove the stagnated heat caused by glucose; during the stage of ying level, treatment should focus on benefiting qi and nourishing yin, to improve the symptoms about deficiency of both qi and yin; during the stage of blood level, treatment should focus on promoting blood circulation and removing blood stasis, to remove the complication. According to the etiology and pathogenesis of diabetes mellitus, the sequential treatment strategy is thus proposed, which is strengthening the spleen to regulate qi flow, clearing heat and resolving turbidity, benefiting qi and nourishing yin, and promoting blood circulation and removing blood stasis. The compound prescriptions such as Houpo Sanwu Decoction, Baihu Jia Renshen Decoction, Danggui Liuhuang Decoction, and Taohong Siwu Decoction are used with modification in the stage-based treatment.

Objective To investigate the effects of Yitangkang on browning of white adipose and PINK1/Parkin pathway of mitophagy in adipose tissue of db/db mice.Methods Totally 30 six-week db/db mice were randomly divided into model group,Yitangkang Group(30 g/kg)and liraglutide group(200 μg/kg),and another 10 C57BL/6 mice of the same age were set as normal group.All groups were treated with corresponding drugs or normal saline for 5 weeks.During the period of administration,the body mass and fasting blood glucose(FBG)of mice in each group were detected regularly,the samples of liver,white and brown adipose of mice were weighed,the contents of serum triglyceride cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)were detected by biochemical analyzer,HE staining was used to observe the pathological changes of inguinal white adipose tissue(iWAT),immunohistochemical staining was used to detect the expression of browning marker protein uncoupling protein-1(UCP1)in iWAT,Western blot was used to detect the expressions of browning-related proteins UCP1,PRDM16,PGC-1α and mitophagy-related proteins PINK1,Parkin,Beclin-1,p62 in iWAT.Results Compared with the normal group,the body mass,liver,white adipose and brown adipose mass of the model group significantly increased(P<0.01),the FBG and serum TG,TC and LDL-C contents significantly increased(P<0.01),and the content of HDL-C significantly decreased(P<0.01);large vacuoles in iWAT adipocytes,the diameter of adipocytes increased obviously,some adipocytes were extruded and deformed,and the edge of adipocytes was not clear,the expressions of iWAT UCP1,PRDM16,PGC-1α and p62 proteins decreased(P<0.01),while the expressions of PINK1,Parkin and Beclin-1 proteins increased(P<0.01).Compared with the model group,the body mass,liver and white adipose mass significantly decreased in Yitangkang group and the liraglutide group(P<0.01),FBG and serum contents of TC,TG and LDL-C were significantly decreased(P<0.05,P<0.01),while HDL-C content significantly increased(P<0.01);the diameter of iWAT adipocytes decreased,the number increased,and the morphology was regular,the expressions of iWAT UCP1,PRDM16,PGC-1α and p62 proteins increased(P<0.01),while the expressions of PINK1,Parkin and Beclin-1 proteins decreased(P<0.05,P<0.01).Conclusion Yitangkang can improve glucose and lipid metabolism and promote browning of white adipose in db/db mice,which may be related to mitophagy mediated by PINK1/Parkin pathway.

Objective:To investigate the clinical epidemiological data of children with prolonged mechanical ventilation (PMV) in pediatric intensive care unit(PICU), and analyze the primary disease of children with PMV as well as the disease characteristics and prognosis of children with PMV under different kinds of primary disease.Methods:The clinical data of hospitalized children with PMV in PICU at Children′s Hospital of Fudan University from January 2019 to December 2020 were retrospectively collected.Results:A total of 46 children with PMV were collected.There were 18 males (39.1%) and 28 females (60.9%). The median age was 37 (8, 86) months and the median body weight was 15 (7, 20) kg.The average pediatric critical illness score at admission was 84.2±7.7, PaO 2/FiO 2 was (245.5±99.8)mmHg.The primary diseases leading to PMV were as follows: there were 14 cases of severe pneumonia, eight cases of severe encephalitis, five cases of bronchopulmonary dysplasia, three cases of upper airway obstruction/craniofacial deformity, three cases of myasthenia, three cases of brain stem tumor, three cases of mitochondrial encephalomyopathy, two cases of spinal muscular atrophy, two cases of Prader-Willi syndrome, one case of dermatomyositis, one case of severe brain injury, and one case of central hypoventilation.The causes of unable to withdraw ventilator were respiratory dysfunction in 24 cases, brain dysfunction in 16 cases, and diaphragm dysfunction in six cases.Compared with neuromuscular diseases, children with PMV caused by respiratory diseases had lower month age, higher preterm birth rate, lower PaO 2/FiO 2 ratio, higher parameters for ventilator treatment, and the differences were statistically significant ( P<0.05). Children with PMV caused by neuromuscular diseases had lower Glasgow coma score and higher coma rate, and the differences were statistically significant ( P<0.05). A total of nine (19.6%) cases underwent tracheotomy.A total of 23 (50.0%) cases were successfully extubated from ventilator, six (13.0%) cases were dependent on invasive ventilator, and six (13.0%) cases were breathing with tracheotomy tube.The median mechanical ventilation time was 33 (28, 40) days, the median PICU hospital stay was 42 (34, 56) days, and the median hospital stay was 51 (41, 65) days.A total of 27 (58.7%) cases were improved and discharged, four (8.7%) cases were transferred to rehabilitation hospital, four (8.7%) cases were transferred to local hospital, and 11 (23.9%) cases died in hospital or at home after giving up. Conclusion:The main causes of PMV in PICU children are respiratory dysfunction, brain dysfunction and diaphragm dysfunction.50.0% of the children with PMV could be discharged from the ventilator, and 23.9% died or died after giving up.

Objective:To explore the effects of external diaphragm electrical stimulation on the diaphragm thickness and function in mechanically ventilated children.Methods:A randomized controlled trial was conducted in children who were admitted to PICU at Children′s Hospital of Fudan University and received mechanical ventilation between June 2021 and April 2022.The control group was given the routine treatment of mechanical ventilation, and the intervention group was given external diaphragm electrical stimulation in the early stage of mechanical ventilation in addition to routine treatment.Diaphragm thickness was continuously measured by bedside ultrasound every day for one week after mechanical ventilation, and the changing trend of diaphragm thickness was observed, and the diaphragmatic thickening fraction (DTf) and the incidence of ventilator-induced diaphragmtic dysfunction(VIDD) were calculated at the same time.Results:A total of 32 valid samples were included, including 15 cases in intervention group (10 males) and 17 cases in control group (11 males). The median age of the patients was 33 (10, 77) months, and the median duration of mechanical ventilation was 12 (8, 21) days.The reasons for mechanical ventilation in children included respiratory insufficiency in ten cases, brain dysfunction in ten cases, heart failure in eight cases, and postoperative surgery in four cases.The diaphragm end-expiratory thickness (DTe) in intervention group and the control group showed a gradually decreasing trend from the 1st day to the 7th day.The left thickness was reduced by 11% on the 7th day compared to 1st day in intervention group, which was reduced by 18% in control group; the average daily DTe was reduced by 2% per day in intervention group and by 3% per day in control group.The trends on the right and left were similar.The DTe thickness in the intervention group was greater than that in control group, among which, the mean DTe thickness in the left side of the intervention group on the 7th day was (0.110 7±0.023 7)cm, which was greater than that in control group (0.093 5±0.016 9)cm, and the difference was statistically significant ( t=-2.372, P<0.05); On the second day, the mean DTe thickness on the right side in the intervention group was (0.1267±0.0277) cm, which was greater than that in control group (0.104 7±0.018 1)cm, and the difference was statistically significant ( t=-2.688, P<0.05). DTf in the intervention group was lower than that in control group at 7th day, but the difference was not statistically significant(left DTf: adjusted mean difference was -0.117, P=0.088; right DTf: adjusted mean difference was -0.065, P=0.277). The incidence of VIDD in the intervention group was lower than that in control group(33.3% vs.41.2%), but the difference was not statistically significant ( χ2=0.005, P=0.946). Conclusion:External diaphragmatic electrical stimulation may be helpful for alleviating diaphragmatic atrophy in mechanically ventilated children.However, whether the improvement of diaphragm atrophy is beneficial to clinical outcome still needs further study.