Objective:To investigate the characteristics and diagnostic methods for the patients with primary lymphedema and interstitial lung disease, as well as the efficacy of thoracic duct or right lymphatic duct plasty.Methods:A retrospective study was performed on 13 patients who were treated for primary lymphedema in the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, from January 2018 to December 2022. All patients were confirmed with interstitial lung disease by high-resolution CT (HRCT) and then underwent thoracic duct or right lymphatic duct plasty surgery. The 13 patients in this study were 7 males and 6 females aged 7.3 (0.7-30.0) years old. Primary lymphedema was the first manifestation in all patients, with an average morbidity age at 1.0 (0-11.0) years old. The average time from the onset of lymphedema to the confirmed interstitial lung disease was 6.3 (0.3-19.0) years. All patients underwent thoracic duct or right lymphatic duct plasty for improvement of the lymphatic flow. In addition, 9 cases (69.2%) received a direct lymphangiography (DLG). In which, 4 cases (44.4%) received further treatment of ligation of the reflux branches, and 1 (11.1%) had the treatment plans changed, because a chylous reflux into the lung through a bronchomediastinal trunk was found from DLG, therefore a ligation of the abnormal reflux branches was performed and a life-long strict low-fat diet was required. Postoperative follow-ups for evaluation of the improvements of lymphedema and pulmonary lymphatic flow were carried out by visit of outpatient clinic or via telephone interviews.Results:All patients recovered well after surgery with an average follow-up time of 47.5 (19.0-68.0) months. Lymphedema was stable in 2 cases (15.4%) and relieved in 11 cases (84.6%). Ten cases (76.9%) had completed the postoperative HRCT reviews and 9 (90.0%) were found with significant improvement in the interstitial lung disease.Conclusion:The interstitial lung disease found during the examination of patients with primary lymphedema can be explained with a lymphatic flow disorder. DLG can identify the cause and make to guide the treatment. Thoracic duct or right lymphatic duct plasty can effectively improve both of the symptom of lymphedema and interstitial lung disease.

[Objective] To summarize the diagnosis and treatment of Antopol Goldman lesion (AGL) in clinical practice. [Methods] Clinical data and diagnosis and treatment process of one AGL case treated in our hospital were retrospectively analyzed, and relevant literature was reviewed. [Results] The patient presented with painless gross hematuria and right-sided lower back pain.Imaging examination suggested swelling of the right kidney, blood accumulation in the right calyx, renal pelvis and lower ureter, blood clot in the bladder, and multiple small stones in the left kidney.After multidisciplinary consultation, close imaging follow-up, interventional and flexible ureterdscope examination, tumors of hematological diseases, renal hematuria, arteriovenous fistula and collection system were excluded.After conservative treatment, the patient gradually recovered.During the follow-up of 1 year, no hematuria or low back pain recurred. [Conclusion] There is no clear diagnostic standard for AGL.Diagnosis relies on imaging, interventional methods and ureteroscopy.It is necessary to exclude other diseases and adopt conservative treatment.

Postoperative pain seriously affects the recovery process of patients, resulting in prolonged hospital stay and increased care costs. Appropriate application of patient-controlled analgesia devices can effectively relieve perioperative acute pain. In 1994 patient-controlled analgesia began to be used in Peking Union Medical College Hospital, and the Acute Pain Service Working Group was established in 2004. With the cooperation of anesthesiologists and specialist nurses, the group jointly has implemented the whole process and standardized management based on patient-controlled analgesia, and constantly improved and innovated working methods, laying a solid foundation for the development of postoperative pain management. This paper systematically reviews and summarizes the work from the aspects of clinical focus, nursing management experience, promotion and dissemination of pain treatment concepts, and development of acute pain service model under the new situation, with the hope of providing valuable reference for comprehensively strengthening pain management in the process of diagnosis and treatment, and enhancing patients' satisfaction with perioperative analgesia services.

Central post-stroke pain (CPSP), a neuropathic pain syndrome occurring after a cerebrovascular accident, is characterized by pain or paraesthesia in the part of the body dominated by the area of the brain where blood vessels are injured. CPSP patients are often accompanied by anxiety, depression and other emotional disorders, which have a serious negative impact on patients' quality of life. However, the pathogenesis of CPSP has not been fully elucidated, the clinical diagnosis rate is not high, and the commonly used treatment methods are not effective. This article reviews the clinical features, epidemiology, pathogenesis and treatment of CPSP in order to provide reference for the elucidation of CPSP mechanism and effective treatment.

Objective To explore the mechanism of miR-421 affecting the occurrence and development of depression.Methods A depressive rat model was established by single intraperitoneal injection of lipopolysaccharide(LPS),and depressive behavior was detected by glucose preference test and open-field test.miRNA microarray chips and RT-PCR were used to analyze the expression level of miR-421 in hippocampus of the depressed rats.TargetScan database and mi RDB database were used to predict the target genes of miR-421.Dual luciferase reporter gene assay was used to observe the binding of miR-421 to the target genes.The impact of over-expression and inhibition of miR-421 on target genes was observed,then the influence of over-expression and inhibition of target genes on downstream factors was observed,and the related mechanism of miR-421 on depression was explored.Results miRNA microarray chips and RT-PCR assay showed that miR-421 was highly expressed in the hippocampus of the depressed rats(P<0.001),Inhibition of miR-421 expression could significantly restore the body weight and exercise ability of the depressed rats(P<0.001).Binding targets of Menin and miR-421 were predicted by TargetScan database,and interaction between Menin and miR-421 was demonstrated by dual-luciferase reporter gene assay.Menin expression was down-regulated while miR-421 was overexpressed(P<0.001),whereas it was up-regulated as miR-421 was inhibited(P<0.001).qPCR indicated that expressions of Caspase-3 and NF-κB in the hippocampus of the depressed rats was significantly increased(P<0.001),and IL-1β expression in the hippo-campus was significantly increased(P<0.01).When the expression of Menin was inhibited,the expressions of Caspase-3,NF-κB and IL-1β were increased(P<0.001),while the expressions of Caspase-3,NF-κB and IL-1β were decreased when Menin was overexpressed(P<0.001).Conclusions Inhibition of miR-421 expression can increase Menin expression,decrease Caspase-3 content,and reduce neuroinflammatory response,thereby improving depressive symptoms.

Postoperative nausea and vomiting(PONV)is a common complication of general anes-thesia.PONV makes negative influence on recovery and prolongs hospital stays.In addition toantiemetic prophylaxis,electrical acupoint stimulation(EAS)has been widely applied in clinical scenario and signifi-cantly reduces PONV incidence,but its mechanism,stimulation parameters,and combined efficacy with pharmacological strategy remain unclear.This article reviews the stimulation parameters,efficacy,safety,and mechanism of EAS for PONV prevention.This review aims to provide insights for future studies.

Objective:To investigate the characteristics, diagnosis and therapeutic effect of acquired lymphangiectasia of the vulva (ALV).Methods:A retrospective analysis of clinicopathological and follow-up data was conducted on the patients treated in Capital Medical University Affiliated Beijing Shijitan Hospital due to female ALV from July 2009 to July 2023. The patients who completed the staged operations [partial labiectomy and reconstruction + thoracic ductplasty and (or) perineal lymphovenous anastomosis] were included in the study and followed up. The improvement of perineal swelling, blister range, fluid leakage volume and frequency were evaluated through outpatient visits by the symptom rating scale of ALV (hereinafter referred to as the symptom rating scale) before and after surgery.Results:A total of 48 patients were treated due to ALV from July 2009 to July 2023, of which 98% (47/48) were postoperative pelvic malignant tumors and 94% (45/48) had a history of radiotherapy. A total of 10 patients with ALV who completed the staged operations were included in this study. (1) Clinical characteristics and diagnosis: 10 patients had a median age of 60 years old (50, 63 years old ). The median duration from cervical cancer surgery and radiation therapy to vulvar swelling was 1.5 years (0.0, 2.0 years), and the median duration from vulvar swelling to blister formation and leakage was 0.0 years (0.0, 4.8 years). Seven patients (7/10) had a history of recurrent erysipelas; 7 patients (7/10) had the most severe symptom (widespread blisters, persistent fluid leakage, and large amount of fluid leakage); noncontrast magnetic resonance lymphography (NCMRL) showed edema signals in the perineal region of all the patients, and increase of agent in the perineal region was observed in lymphoscintigram (LS). (2) Surgical treatment and postoperative pathological examination: of the 10 ALV patients who completed staged surgical treatment, 6 cases (6/10) were diagnosed with thoracic duct outlet obstruction and underwent thoracic ductplasty and partial labiectomy and reconstruction. Perineal lymphovenous anastomosis and partial labiectomy and reconstruction were performed in 4 cases (4/10) without thoracic duct outlet obstruction. Postoperative routine pathological examination of 10 patients (10/10) showed dermal papilla lymphangiectasia. Immunohistochemical tests were performed on 5 patients, all of which were positive for D2-40 and negative for CD 34. (3) Efficacy: 8 patients completed the postoperative follow-up, and the median follow-up time was 31.0 months (17.5, 78.3 months). The perineal swelling and the blister fluid leakage were all significantly improved after the staged operations. All indexes of the symptom rating scale, including the degree of perineal swelling, blister range, fluid leakage volume and frequency, were significantly improved in 8 follow-up patients, and 3 (3/8) of them were cured; the median symptom score decreased significantly from 11.0 before surgery to 3.0 after surgery ( P<0.001). The incidence of erysipelas was significantly reduced from 7/10 before surgery to 2/8 after surgery ( P=0.035). Conclusions:The main causes of female ALV are pelvic tumor surgery and radiotherapy. The clinical diagnosis is made from relevant medical history, clinical manifestations, LS and magnetic resonance imaging. The diagnosis is confirmed by histopathological findings. Pathological results show lymphangiectasia in the dermal papilla, and immunohistochemical staining show positive for D2-40 and negative for CD 34. The effect of staged surgery on ALV is remarkable and even cured, and could effectively reduce the incidence of erysipelas.

To improve the current situation of multiple preoperative visits and evaluations for elderly patients and other patients with complex conditions, in December 2022, Peking Union Medical College Hospital established preoperative multidisciplinary evaluation clinic (shorted as joint clinic). The joint clinic established a multidisciplinary team, clarified service targets, and developed standardized clinic workflows to provide patients with a " one-stop" preoperative assessment(physical fitness assessment, nutritional assessment, and frailty assessment, etc.), nutritional optimization intervention, and prerehabilitation education and guidance services. This practice strengthened preoperative risk management, improved preoperative assessment efficiency, and ensured the safety of patients during the perioperative period. As of September 2023, the joint clinic had received a total of 128 patients, of which 86 underwent surgery after preoperative evaluation and prehabilitation optimization. The obesity rate, smoking rate, and number of frailty cases of these patients had decreased from 13.96%, 11.63%, and 18 at the time of visit to 9.30%, 4.65%, and 14 on the day before surgery, respectively. They had recovered well after surgery. This practice had improved the preoperative status of patients and created conditions for high-risk patients to undergo surgery smoothly, so as to provide references for other hospitals to carry out multidisciplinary collaborative preoperative evaluation works.

OBJECTIVE To provide reference for clarifying improvement effects of Anemarrhena asphodeloides on sepsis- induced myocardial injury and potential material basis. METHODS Water extract of A. asphodeloides was extracted by thermal reflux method. Total xanthone and total saponins in A. asphodeloides were separated by macroporous adsorption resin. The mice model of sepsis-induced myocardial injury was established by intraperitoneal injection of lipopolysaccharide. The effects of the location of three extraction fractions and the monomers of A. asphodeloides as mangiferin， timosaponin AⅢ and timosaponin BⅡ on the survival rate of the model mice were explored. HE staining was used to observe the effects of mangiferin， timosaponin AⅢ and timosaponin BⅡ on myocardial morphology in model mice. The effects of mangiferin on mRNA expressions of inflammatory cytokines [interleukin-6 （IL-6）， IL-1β and tumor necrosis factor-α （TNF-α）] and the level of reactive oxygen species （ROS） in myocardial tissue of model mice were detected. RESULTS Compared with the model group， the survival rate of mice in the intervention group of total xanthone， total saponins and water extract was increased to different extents， especially total xanthone fraction. Mangiferin， timosaponin AⅢ and timosaponin BⅡcould improve the degree of myocardial cell swelling and muscle bundle arrangement disorder in model mice， especially mangiferin. Compared with model group， mRNA expressions of IL-6， IL- 1β and TNF- α， ROS level in myocardium of mice after mangiferin intervention were decreased to different extents. CONCLUSIONS The different extraction fractions of A. asphodeloides can improve survival rate of mice with sepsis-induced myocardial injury， especially total xanthone fraction. Mangiferin is the best among the three monomers of A. asphodeloides to improve sepsis-induced myocardial injury， which may play a role in anti-sepsis myocardial injury by anti-inflammation and antioxidantion.