Objective To explore the effect of ziprasidone combined with low dose of olanzapine in the treat-ment of schizophrenia with depressive symptoms,and its lipid metabolism.Methods According to the digital table, 108 schizophrenia patients with depressive symptoms were randomly divided into the two groups.The treatment group (n=54)was given starting doses of ziprasidone with 2.5mg/d,increased to 5 -10 mg/d for 1 week.And starting doses of olanzapine with 40mg/d,increased to 120 -160mg/d for 2 weeks.The control group (n=54)was given starting doses of olanzapine with 5mg/d,increased to 10-20mg/d for 2 weeks.The treatment course was 8 weeks.The PANSS score and HAMD score,indicators of obesity and blood lipid and adverse effect were observed.Results The PANSS score and HAMD score in the treatment group[(40.19 ±9.23)vs (59.29 ±10.14)]and the control group [(8.58 ±3.16)vs (12.19 ±4.04)]were significantly lower than those before treatment(t=9.41,4.91,6.51, 5.20,all P<0.05),and the scores in the treatment group were reduced more remarkably(t=5.11,3.01,all P<0.05).The waistline(83.45 ±5.29)cm,BMI(26.95 ±2.53)kg/m2,WHR(23.76 ±2.55)cm in the control group were all increased compared with those before treatment(t=5.14,3.18,all P<0.05)while the indicators[(23.76 ± 2.55)vs (23.76 ±2.55)]above improved more remarkably in the treatment group than those in the control group (t=5.38,4.53,all P<0.05).Compared with before treatment,the level of TC (6.54 ±0.86)mmol/L,TG(2.26 ± 0.83)mmol/L,LDL-C(3.94 ±0.43)mmol/L were increased remarkably,and HDL-C(1.02 ±0.18)mmol/L was reduced in the control group,TC(5.35 ±0.58)mmol/L in treatment group in the treatment group (t=4.20,3.27, 3.91,2.97,4.47,all P<0.05),while the indicators of blood lipid in the treatment group were better than those in the control group (t=3.18,3.01,2.76,2.87,all P<0.05).The TESS score in the treatment group(3.35 ± 0.57)point was lower than that in the control group(4.93 ±1.03)point (t=3.98,P<0.05).Conclusion It is effective and safe of combined with low dose of olanzapine in the treatment of schizophrenia with depressive symp-toms,which can contribute to effectively alleviate symptoms of depression with low effect on body weight and blood lip-id metabolism,less adverse reaction.

OBJECTIVETo investigate the therapeutic effect of facial artery perforator flap for the soft tissue defects at nose, lip and cheek.

METHODSThe facial artery perforator adjacent to the defect was identified by Doppler ultrasonography. The perforator flap was designed according to the defect location, size and shape. The subcutaneous tissue around the perforator was kept as much as possible to protect the venous drainage.

RESULTSFrom Oct. 2012 to Oct.2013, 26 cases were treated with facial artery perforator flaps, with 9 cases of nasal defects, 10 cases of lip defects and 7 cases of buccal defects. The defects size ranged from 1.5 cm x 2.0 cm to 3.0 cm x 3.0 cm and the flaps size ranged from 2.0 cm x 2.5 cm to 3.5 cm x 3. 5 cm. Superficial necrosis(3mm in width) happened at the end of one flap. All the other 25 flaps survived completely. 16 cases were followed up for 3 months to 2 years with no relapse and satisfactory cosmetic and functional results were achieved.

CONCLUSIONSBoth cosmetic and functional effect can be achieved with facial artery perforator flap for defects at nose, lip and cheek.

Arteries ; Cheek ; surgery ; Graft Survival ; Humans ; Lip ; surgery ; Nose ; surgery ; Perforator Flap ; blood supply ; transplantation ; Rhinoplasty ; methods

Objective To evaluate the safety and efficacy of Viabahn covered stent in treatment of hepatic artery pseudoaneurysm (HAPA) caused by surgery.Methods Clinical data of 7 patients with postoperative massive intra-abdominal hemorrhage and diagnosed as HAPA with emergency angiography were collected from November 2015 to May 2016.All the patients underwent Viabahn covered stent implantation.Perioperative and postoperative clinical data of the patients were recorded,and with 1-month follow-up.Results All the 7 cases were diagnosed as extrahepatic HAPA and successfully completed Viabahn covered stent procedure,and curative rate was up to 100％.One case experienced transient vasospasm in the hepatic artery proximal to the stent.All the patients repeated hepatic artery CT angiography scans one week after surgery,with no evidence of bleeding.With 1-month follow-up,all the patients were in stable conditions.Conclusion Viabahn covered stent is minimally invasive,simple and effective interventional approach for HAPA.

Objectives To explore the effect and mechanism of saikosaponin D on cellular autophagy of ICCs by regulating the CaMKKβ/AMPK signaling pathway.Methods Rat primary ICCs cells were isolated and stimulated with glutamate to construct an autophagy model.The Ca2+level was detected by immunofluorescence.Primary ICCs cells were divided into control group,model group,model+saikosaponin D group,model+CaMKKβ inhibitor group,and model+saikosaponin D+CaMKKβ inhibitor group.The ultrastructure of autophagosomes was observed by transmission electron microscopy.The levels of Ghrelin and SP were detected by ELISA.The expressions of Ca2+and LC-3Ⅱ were detected by immunofluorescence.The protein expression levels of LC-3Ⅱ/Ⅰ、CaMKKβ,p-AMPK,Drp1,MFN2,IP3R and RyR were detected by Western blot.Results The fluorescence expression of LC-3Ⅱ was enhanced.Saikosaponin D reduced the levels of CaMKKβ,AMPK and MFN2(P<0.01),and increased the levels of LC-3Ⅱ/Ⅰ、IP3R,RyR,Drp1,Ghrelin and SP(P<0.01).The effect of Saikosaponin D combined with CaMKKβ inhibitor STO-609 was more significant.Conclusion Saikosaponin D can mediate Ca2+outflow through the CaMKKβ/AMPK signaling pathway,and affect the expression of excessive autophagy and gastrointestinal motility-related factors in ICCs cells.

Objective To compare the pathological status of gastric mucosa and the expression of HH-PTCH-SMO-GLI(Hedgehog signaling pathway)and NOX/NF-κB/STAT1 signaling pathways in Hp and non-HP infected CAG patients,and to explore the biological mechanism of Hp promoting the"inflammatory cancer transformation"of CAG.Methods 43 patients with CAG who met the criteria were enrolled and divided into CAG with Hp infection group(Hp+ CAG group,n=21)and CAG without Hp infection group(HP-CAG group,n=22).The histological changes of gastric mucosa were observed by hematoxylin-eosin(HE)staining.Western blot was used to detect the relative expression levels of NOX1,NOX2,NOX4,STAT1,P65 and P-P65 in gastric mucosa.Real-time fluorescence quantitative PCR(RT-qPCR)was used to detect Gli1 mRNA,Gli2 mRNA,Gli3 mRNA,Shh mRNA,Smo mRNA,Ptch mRNA,NOX1 mRNA,NOX2 mRNA,NOX4 mRNA and NF-κB mRNA in gastric mucosa The mRNA level.Results HE staining results of gastric tissues in the two groups:In the Hp+CAG group,gastric epithelial cells were partially necrotic and shed,the surface was not smooth,the number of glands was reduced and disordered,intestinal metaplasia was observed,and diffuse lymphocyte and neutrophil infiltration were observed in the lamina proper.The degree of lymphocyte and neutrophil infiltration in HP-CAG group was lighter than that in Hp+CAG group.RT-qPCR results:Compared with HP-CAG group,the levels of Gli1 mRNA,Shh mRNA,Smo mRNA and Ptch mRNA in gastric mucosa of Hp+CAG group were significantly decreased(P<0.01).The levels of Gli2 mRNA,Gli3 mRNA,NOX1 mRNA,NOX2 mRNA,NOX4 mRNA and NF-κB mRNA were significantly increased(P<0.01).Western blot detection results:Compared with hP-CAG group,the relative expression levels of NOX1/GAPDH,NOX2/GAPDH,NOX4/GAPDH and P-P65/GAPDH in gastric mucosa of Hp+CAG group were significantly increased(P<0.01),and the STAT1 level was significantly decreased(P<0.01).There was no significant difference in the relative expression of P65/GAPDH between the two groups(P>0.05).Conclusion Hp infection may cause long-term inflammation of gastric mucosa,promote atrophy and intestinal metaplasia,and increase the risk of cancer by inhibiting hH-PTC-SMO-GLi signaling pathway and abnormal activation of NOX/NF-κB/STAT1 signaling pathway.

Ohjective To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of sinusoidal obstruction syndrome (SOS) caused by gynura segetum.Methods The clinical data of 9 patients with SOS caused by gynura segetum (5 males and 4 females) who underwent TIPS were retrospectively analyzed from February 2017 to June 2018.The Child-Pugh scores were (9.5 ± 1.3) and the MELD scores were (12.5 ± 5.0).The success rates,complications and follow-up results were evaluated.Results TIPS was performed successfully in all the 9 patients.The portal venous pressure gradient dropped from (22.4 ± 2.7) mmHg to (10.4 ± 3.2) mmHg (P ＜ 0.05).There was no complication such as abdominal hemorrhage and biliary peritonitis.Nine patients were followed-up for 1 ～17months,mean 7.8 ± 6.0 months.One month after treatment,the Child-Pugh scores were (7.1 ± 1.8),compared with that of the preoperative scores,the difference was statistically significant (P ＜ 0.05).The MELD scores were (5.3 ± 4.6),compared with that of the preoperative scores,the difference was also statistically significant (P ＜ 0.05).At the end point of the follow-up,color Doppler ultrasound and portal CTA showed that the TIPS shunt was patent and hepatic congestion was relieved in all the 9 patients.All patients were alive.Conclusion TIPS was a safe and efficacious treatment for SOS caused by gynura segetum.

Objective:To discuss the medication, prescription law and academic thoughts of doctors in the Ming and Qing Dynasties for the treatment of abdominal tympanites based on the Yi An Lei Ju. Methods:The medical records of doctors in the Ming and Qing Dynasties for the treatment of tympanites contained in Yi An Lei Ju were retrieved, and the prescription information was extracted. Based on R4.2.1 and the TCM inheritance calculation platform V3.0, the frequency, property and taste, and meridian tropism, and efficacy categories of drugs were counted, and association rules analysis and clustering analysis were performed. Results:A total of 214 prescriptions were included, involving 239 kinds of Chinese materia medica, with a total frequency of 2 080 times. The high-frequency drugs (frequency≥30) were Poria, Citri Reticulatae Pericarpium, Alismatis Rhizoma, Atractylodis Macrocephalae Rhizoma, Aconiti Lateralis Radix Praeparata, etc. The medicinal properties of the drugs were mainly warm, neutral and cold. The flavors were mainly pungent, sweet and bitter. The meridians were mainly spleen, liver and kidney meridians. The efficacy categories were mainly tonic drugs, diuresis and dampness drugs, and qi-regulating drugs. Association rule analysis found that the most frequently used drug pair was Poria-Citri Reticulatae Pericarpium. Clustering analysis showed that drugs (frequency≥20) could be divided into 4 clusters.Conclusions:Doctors in the Ming and Qing Dynasties treated abdominal tympanites with the basic treatment methods of invigorating the spleen and promoting diuresis, soothing the liver and regulating qi, warming the kidney and resolving fluid retention. The medication took into account the ascending and descending of qi, the combination of attack and supplement, the combination of cold and heat, and the harmony of qi and blood.

ObjectiveTo investigate the possible mechanism of compound Yinqi Sanhuang Jiedu Decoction （茵芪三黄解毒汤， YSJD） against the progression of hepatic fibrosis （HF）. MethodsThirty-eight C57BL/6J mice were randomly divided into blank group， model group， silybin group and low-， medium- and high-dose YSJD groups， with eight mice in the model group and six mice each in other groups. Except for the blank group， all mice were injected intraperitoneally with 10% carbon tetrachloride （CCl₄） to establish a HF model， twice a week for 8 weeks. The drug intervention started one week after the first modeling； the low-， medium- and high-dose YSJD groups were given 8.325， 16.65 and 33.3 g/（kg·d） of YSJD suspension by gavage， respectively， while the silybin group was given 55 mg/（kg·d） of silybin suspension by gavage， and the blank group and the model group were given 0.2 ml normal saline by gavage， all for 8 weeks. The liver hardness of living mice was observed using a small animal ultrasound detector， and grey-scale ultrasound was recorded. The liver tissue was observed by Sirius scarlet staining， and the proportion of collagen fiber deposition was calculated. Liver function indicators including alanine aminotransferase （ALT） and aspartate aminotransferase （AST）， and serum laminin （LN）， hyaluronic acid （HA）， pre-collagen type III （PCIII） and collagen type IV （CIV） were also detected. The protein expression of transforming growth factor β1 （TGF-β1）， Vimentin， E-cadherin， α smooth muscle actin （α-SMA） in liver tissue were detected. ResultsCompared to the blank group， the model group showed increased gray value， collagen deposition，serum ALT， AST， HA， LN and PCIII levels， decreased expression of E-cadherin， and increased expression of N-cadherin，α-SMA，Vimentin and TGF-β1 in liver tissues （P＜0.05）. Compared to the model group， the ultrasonic gray value and the proportion of collagen fiber deposition in liver of silybin group and YSJD medium- and high-dose groups decreased， and the serum ALT， AST， LN， HA and PCⅢ levels decreased. Compared to the model group， the expression of E-cadherin in liver tissues of silybin group and all three YSJD groups increased， while the expressions of N-cadherin， Vimentin， TGF-β1 and α-SMA decreased （P＜0.05）， and among them， most improvements were seen in the medium-dose YSJD group （P＜0.05）. ConclusionThe effect of YSJD on significantly reducing the extent of HF in mice caused by CCl₄ may be related to its ability to regulate liver hardness and inhibit the occurrence of epithelial mesenchymal transition in mice.

In recent years， the continuous advances in material sciences and techniques have helped with the establishment and development of liver organoids that can simulate the structure and function of organs in vivo. In addition to the research on traditional biological factors， the construction of microenvironments with different mechanical cues to investigate the influence of mechanical stimulation on the growth of liver organoids has also become a research focus. This article first discusses the development of liver organoids and then reviews the influence of mechanical forces of different properties on the formation of liver organoids， so as to lay a foundation for the construction of more complex and ordered liver organoids in vitro and provide ideal research models for understanding the interaction between biological and mechanical factors in the formation of liver organoids.

This article is to illustrate the connection between neutrophil extracellular traps （NETs） and stasis-toxin interactions during the development of liver cancer， and to provide ideas for the prevention and treatment of liver cancer. It is believed that the mechanism of tumor-related thrombosis formation caused by NETs is closely related to "stasis" in traditional Chinese medicine （TCM）， and the continuous maintenance or enhancement of tumor microenvironment by NETs is closely related to "toxin" in TCM； the strong coagulation-promoting effect of NETs makes the local microenvironment， which can be regarded as the toxin caused by blood stasis； the changes of tumor microenvironment induced by NETs further induced platelet aggregation， which may present a state of stasis caused by toxin； the pathological changes of liver cancer caused by NETs can be regarded as the microscopic manifestation of the mechanism of stasis-toxin interaction of liver cancer.