Objective To observe the clinical curative effects of Changwei Shu combined with conventional western medicine therapy in treating the sepsis patients with gastrointestinal dysfunction.Methods A total of 120 cases of sepsis patients with gastrointestinal dysfunction were randomly divided into treatment group and control group,60 patients in each group.The control group was given conventional western medicine therapy,and the treatment group was given Changwei Shu combined with conventional western medicine therapy.After treatment for 7 days,the clinical efficacy and safety were evaluated by observing the changes in white blood cell (WBC) count,procalcitonin (PCT) level,intra-abdominal pressure (IAP),gastrointestinal dysfunction scores,and scores of acute physiology and chronic health evaluation (APACHE Ⅱ).Results (1) For one case dropped out and one was excluded from the treatment group,and 4 cases dropped out and 2 were excluded from the control group,a total of 58 cases in the treatment group and 54 in the control group were included into the study at the end of the trial.(2) The total effective rate of the treatment group was 91.38％ and that of the control group was 88.89％,the difference being significant (P ＜ 0.05).(3) After treatment,WBC count,PCT level and IAP of the two groups were improved (P ＜ 0.01 compared with those before treatment),and the improvement of the treatment group was superior to that of the control group (P ＜ 0.01).(4) After treatment,gastrointestinal dysfunction scores and APACHE Ⅱ scores of the two groups were decreased(P ＜ 0.01 compared with those before treatment),and the decrease of the treatment group was superior to that of the control group (P ＜ 0.01).(5) During the treatment,4 cases from the treatment group had nausea,and 5 cases from the control group had nausea and abdominal distention,and the symptoms disappeared spontaneously one week later.No obvious changes were found in the hepatic and renal function of the two groups.Conclusion Changwei Shu exerts an effect on reducing the inflammation,improving the gastrointestinal function,and relieving the illness severity of sepsis patients with gastrointestinal dysfunction.

Objective To analyze the literature of leech in medicine using CiteSpace knowledge map,comprehensively understand the research status,hotspots and development trends of component analysis and pharmacological effects of leech,and provide reference for researchers in the field of leech.Methods CiteSpace 6.1 R3 software was used to analyze the relevant literature of leech in the field of medical research in CNKI and Web of Science databases from 1996 to 2022.The bibliometric and visual analysis of the number of articles,authors,research institutions,keyword co-occurrence,clustering and emergence were carried out.Results A total of 1 115 Chinese articles in CNKI database and 237 English articles in Web of Science database were included.The analysis of Chinese and English literature showed that the author Shi Hongzhuan had the largest number of Chinese articles,and the German author Hildebrandt had the largest number of English articles.Shandong University of Traditional Chinese Medicine and Chinese Academy of Sciences were the institutions with the largest number of articles in Chinese and English respectively.The country with the most published English literature is the United States.Chinese and English keyword co-occurrence and cluster analysis showed that Chinese literature focused on the study of its active ingredient hirudin,including molecular structure,pharmacological efficacy,mechanism of treating thrombosis,coronary heart disease,kidney disease and other diseases,and paid attention to the differences in the active ingredients of different types of leeches.In addition,English literature focused on the clinical external use of living leeches.The emergence of keywords suggested that the mechanism of action,the search and synthesis of hirudin analogues,and the pharmacodynamic mechanism of compatibility application were not only the current research hotspots,but also the future hot spots.Conclusion The analysis of leech components,the pharmacological mechanism of leech in the treatment of cardiovascular diseases,chronic kidney diseases and other diseases have always been the research hotspots.Hirudin analogues,the pharmacodynamic mechanism of compatibility application,network pharmacology,molecular docking and so on may be the future research hotspots and trends of leeches.

Objective To evaluate the CT features of small lung invasive adenocarcinoma with air?containing space and its relationship with pathological types, and to explore the pathological basis of air?containing space. Methods CT and pathological data of fifty patients with surgically proven lung invasive adenocarcinoma with air?containing space in our hospital from January 2012 to December 2017 were retrospectively reviewed. CT image analysis included image features of tumor and air?containing space. Pathological analysis included pathological subtype, differentiation degree. CT features of tumor and air?containing space were compared with regard to pathological types using chi?square test or Fisher exact text. Analysis of variance was used to compare quantitative data satisfying normal distribution, while those data not satisfying normal distribution were compared with Kruskal?Wallis test. In addition, Spearman correlation was used to analyze the correlation between nodule density and pathological types. Results (1) CT features of tumors: Tumors were predominantly located in peripheral lungs (46/50). Most of the tumors were subsolid nodules (37/50). Tumor?lung interface was generally clear (46/50). Tumors are often accompanied by malignant signs such as lobulation (37/50), spicule sign (27/50), air bronchogram sign (43/50), and pleural indentation (36/50). The mean diameter of nodules ranged from 7.50 mm to 18.12 mm, with an average of (12.91±2.85)mm. The nodule density ranged from-657.00 to 73.00 HU with an average of (-213.88±206.16) HU. (2) CT features of air?containing space:Air?containing spaces were commonly solitary (37/50) and were found to be mainly in an eccentric distribution (29/37). The maximum diameter of air?containing space ranged from 1.00 to 16.00mm, and the average diameter was (4.23±3.14)mm. Air?containing spaces less than 5mm were found in 35 cases (70%), and air?containing spaces more than 5mm were found in 15 cases. (3) Comparison of CT features and corresponding pathological types: Nodule density, number of air?containing space, and type of nodule density in different pathological types were statistically different (P<0.05). There was a correlation between nodule density and pathological subtypes (r=0.371, P=0.008). Differences of nodule density, short?dimension of nodule, type of nodule density, spicule sign, pleural indentation among different tumor differentiation degrees were significant (P<0.05). The degree of tumor differentiation was negatively correlated with nodule density (r=-0.451, P=0.001). Conclusion The detection rate of air?containing space in lung invasive adenocarcinomas is 12.7%. Most small lung invasive adenocarcinomas with air?containing space are presented as peripheral subsolid nodule, and there is a certain correlation between their CT features and pathological types. The pathological basis of air?containing space was supposed to be dilated distal bronchiole induced by check?valve mechanism and destruction of alveolar structure by tumor.

Objective:To systematically review the predictive model for de novo stress urinary incontinence (de novo SUI) after pelvic organ prolapse (POP) surgery, with the aim of providing reference for preventing the occurrence of de novo SUI.Methods:Literature on the prediction model of de novo SUI after POP surgery was electronically retrieved in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang, and VIP. The search period was from the establishment of the database to December 31, 2023, and the language was limited to Chinese and English. Two researchers independently screened literature, extracted data, and used the prediction model risk of bias assessment tool (PROBAST) to evaluate the quality of the models.Results:A total of 13 articles were included, including 13 de novo SUI risk prediction models. One literature was a prospective study, one literature was a secondary analysis of data, and the rest were retrospective studies. The area under the receiver operating characteristic curve in nine models ranged from 0.595 to 0.842, and the C-index of three models ranged from 0.710 to 0.738. Five models were not validated or only internally validated after construction. Six models were validated in one external population. The predictive performance of one model was validated in six external populations. The overall applicability of the 13 prediction models was good, but there was a certain risk of bias in all of them. Conclusions:There is a significant difference in the predictive performance of the de novo SUI risk prediction model after POP surgery, and the number is relatively small, indicating that it is still in the development stage. Future research should continuously optimize existing models and conduct external validation, and construct predictive models suitable for postoperative de novo SUI in POP patients in China.

Objective:To explore the clinical effects of parallel combined flow-through perforator flaps in the treatment of circular hot crush injuries in limbs with blood supply disorder.Methods:The study was a retrospective observational study. From April 2016 to December 2022, 4 cases with circular hot crush injuries in limbs with blood supply disorder were admitted to the Department of Burns and Plastic Surgery of the 988 th Hospital of Joint Logistics Support Force of PLA, including 3 males and 1 female, aged from 24 to 48 years. Among them, 2 cases were injured in the calf and 2 cases were injured in the forearm. After emergency debridement, the area of skin and soft tissue defects was from 20 cm×20 cm to 44 cm×20 cm. The patients had defects in tibialis anterior and posterior tibial arteries with a length of 13 to 18 cm, and in ulnar and radial arteries with a length of 9 to 12 cm. Flaps were designed and cut, including a flow-through anterolateral thigh perforator flap with area of 20 cm×9 cm to 24 cm×21 cm carrying the descending branch of the lateral circumflex femoral artery and the accompanying veins of 8 to 18 cm in length; and a flow-through posterior tibial artery perforator flap with area of 21 cm×13 cm and 20 cm×14 cm carrying the posterior tibial artery, the accompanying veins with a length of 14 and 17 cm respectively, and the great saphenous vein with a length of 22 and 21 cm. The circular hot crush injury wounds in the calf with blood supply disorder were repaired by a parallel combination of flow-through posterior tibial artery perforator flap and flow-through anterolateral thigh perforator flap, and the circular hot crush injury wounds in the forearm with blood supply disorder were repaired by a parallel combination of bilateral flow-through anterolateral thigh perforator flap, and the injured main vessels were reconstructed. The donor site wounds of flap were closed directly or treated with split-thickness skin grafts from abdomen. After surgery, the blood supply and survival of the flap and distal affected limb, the healing of wounds in the donor and recipient sites, the survival of the skin graft in the flap donor site were observed. During follow-up, the condition of flaps, the appearance, blood supply, and function of affected limbs were observed. At the last follow-up, the foot and ankle functions were evaluated according to the scoring standards of American Orthopedic Foot and Ankle Association, and the wrist and hand function was evaluated according to the trial standard of replantation of amputated upper limb function assessment of the Hand Surgery of Chinese Medical Association. Results:The flaps and distal affected limbs of 4 patients had good blood circulation and successfully survived after surgery. The wounds of 3 cases successfully healed, while one patient with circular hot crush injury in the forearm experienced exudation in the recipient site in the later stage, and the wound healed after re-expansion and suturing. The donor site wounds healed smoothly, and the skin grafts successfully survived. During follow-up of 12 to 24 months after surgery, the flaps were slightly swollen, the limbs had good appearance, normal blood circulation, and fine functional recovery. At the last follow-up, the foot and ankle function of 2 patients with circular hot crush injuries in the calf was evaluated as good in 1 case and commonly in 1 case; the wrist and hand function of 2 patients with circular hot crush injuries in the forearm was evaluated as excellent in 1 case and good in 1 case.Conclusions:The parallel combined flow-through perforator flap can reconstruct the damaged main blood vessels and repair the wound at the same time. It can not only effectively save the limb, but also restore part of the function of the affected limb. It is one of the effective methods to treat the circular hot crush injuries in limbs with blood supply disorder.

Objective: To evaluate the CT features of small lung invasive adenocarcinoma with air-containing space and its relationship with pathological types, and to explore the pathological basis of air-containing space. Methods: CT and pathological data of fifty patients with surgically proven lung invasive adenocarcinoma with air-containing space in our hospital from January 2012 to December 2017 were retrospectively reviewed. CT image analysis included image features of tumor and air-containing space. Pathological analysis included pathological subtype, differentiation degree. CT features of tumor and air-containing space were compared with regard to pathological types using chi-square test or Fisher exact text. Analysis of variance was used to compare quantitative data satisfying normal distribution, while those data not satisfying normal distribution were compared with Kruskal-Wallis test. In addition, Spearman correlation was used to analyze the correlation between nodule density and pathological types. Results: (1) CT features of tumors: Tumors were predominantly located in peripheral lungs (46/50). Most of the tumors were subsolid nodules (37/50). Tumor-lung interface was generally clear (46/50). Tumors are often accompanied by malignant signs such as lobulation (37/50), spicule sign (27/50), air bronchogram sign (43/50), and pleural indentation (36/50). The mean diameter of nodules ranged from 7.50 mm to 18.12 mm, with an average of (12.91±2.85)mm. The nodule density ranged from-657.00 to 73.00 HU with an average of (-213.88±206.16) HU. (2) CT features of air-containing space: Air-containing spaces were commonly solitary (37/50) and were found to be mainly in an eccentric distribution (29/37). The maximum diameter of air-containing space ranged from 1.00 to 16.00mm, and the average diameter was (4.23±3.14)mm. Air-containing spaces less than 5mm were found in 35 cases (70%), and air-containing spaces more than 5mm were found in 15 cases. (3) Comparison of CT features and corresponding pathological types: Nodule density, number of air-containing space, and type of nodule density in different pathological types were statistically different (P<0.05). There was a correlation between nodule density and pathological subtypes (r=0.371, P=0.008). Differences of nodule density, short-dimension of nodule, type of nodule density, spicule sign, pleural indentation among different tumor differentiation degrees were significant (P<0.05). The degree of tumor differentiation was negatively correlated with nodule density (r=-0.451, P=0.001). Conclusion The detection rate of air-containing space in lung invasive adenocarcinomas is 12.7%. Most small lung invasive adenocarcinomas with air-containing space are presented as peripheral subsolid nodule, and there is a certain correlation between their CT features and pathological types. The pathological basis of air-containing space was supposed to be dilated distal bronchiole induced by check-valve mechanism and destruction of alveolar structure by tumor.