Nuclear radiation exposure events and tumor radiotherapy are highly susceptible to a range of psychological, physiological and other health problems, which can seriously affect patients' quality of life. It has been shown that 87.5 % of tumor patients are exposed to varying degrees of radiation injury during radiotherapy. The treatment of radiation injury (RI) in modern medicine is limited to drug therapy, cell therapy, etc. Among them, the most chemical drugs cause many adverse reactions including fatigue, nausea, vomiting, etc., and there are very few drugs dedicated to the treatment of RI. Traditional Chinese medicine (TCM) is a rich natural medicinal resource, which has a wide range of pharmacological activities, multiple targets of action and minimal toxic side effects. Many studies have demonstrated that TCM and its compound preparations have enormous potential in the treatment of radiation induced comprehensive diseases. However, TCM is limited in clinical application due to its slow onset of action, complex active ingredients, and low bioavailability. Therefore, the article reviews the application, molecular mechanisms, and new dosage forms of TCM in the prevention and treatment of RI. On this basis, we will focus on discussing the development advantages and application prospects of the combination of traditional Chinese and Western medicine to achieve highly efficient treatment of RI. This review aims to provide scientific and effective drug delivery strategies and basic theoretical support for the clinical effective treatment of RI with TCM, and further promote the innovative development of TCM.

Objective To observe the effect of ultrasound-guided iliopsoas plane block(IPB)on the quality of postoperative recovery in patients undergoing hip arthroplasty.Methods Sixty patients who underwent hip arthroplasty were selected,37 males and 23 females,aged 40-79 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ.The patients were divided into two groups by random number table method:the iliopsoas plane block group(group IPB)and the femoral nerve block(FNB)group(group FNB),30 pa-tients in each group.Before anesthesia induction,IPB was performed with 0.5%ropivacaine 10 ml and lat-eral femoral cutaneous nerve block was performed with 0.5%ropivacaine 5 ml in group IPB.And FNB was performed with 0.5%ropivacaine 10 ml and lateral femoral cutaneous nerve block was performed with 0.5%ropivacaine 5 ml in group FNB.The dosages of propofol,remifentanil,and cis-atracurium during operation were recorded.The quality of recovery-15(QoR-15)scale was evaluated preoperatively and postoperatively 1 day,2 and 3 days.The max VAS(VASmax)pain score and manual muscle test(MMT)score of quadri-ceps muscle were recorded 12,24,and 48 hours after surgery.The time of getting out of bed for the first time,opioid dosage,and patient satisfaction were recorded.The incidence of nerve injury,vascular injury,puncture site infection,and local anesthetic poisoning were recorded.The postoperative complications of diz-ziness,nausea and vomiting,deep vein thromboses,and elirium were also recorded.Results There was no significant difference in the dosage of propofol,remifentanil,and cis-atracurium between the two groups.Compared with group FNB,the QoR-15 scale score in group IPB was significantly higher 1 day,2 and 3 days after operation(P＜0.05).Compared with group FNB,the MMT scores of quadriceps muscle was sig-nificantly higher in group IPB 12 and 24 hours after surgery(P＜0.05),and the first time of getting out of bed was shortened in group IPB(P＜0.05).However,there were no significant differences in the VASmax pain score,MMT score of quadriceps muscle 48 hours after surgery,opioid dosage,and patient satisfaction between the two groups.No nerve block related complications were found in both groups.There were no sig-nificant differences in postoperative complications between the two groups.Conclusion The iliopsoas plane block can improve the quality of postoperative recovery and accelerate the recovery of patients with hip re-placement,and the effect is better than that of femoral nerve block.

Objective:To evaluate the effect of heavy smoking on the dose-effect relationship of ciprofol for painless gastroscopy when combined with alfentanil.Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ male patients, aged 18-64 yr, with body mass index of 18-28 kg/m 2, undergoing elective painless gastroscopy from October 2023 to February 2024 in Baoding First Central Hospital, were divided into non-smoking group and heavy smoking group (smoking index>400) according to the status of smoking. Alfentanil 5 μg/kg and ciprofol were intravenously injected, and gastroscopy was performed after the patient′s eyelash reflex disappeared and the jaw was relaxed. The study was performed by the Dixon′s up-and-down method, and the initial dose of ciprofol was 0.4 mg/kg. The dose of ciprofol increased or decreased by 0.04 mg/kg each time based on the positive or negative response of the previous patient. A positive response was defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score being greater than 1 point at 3 min after ciprofol injection or the occurrence of coughing, swallowing, body movement, or other responses that affected the operation during the insertion of the endoscope. The median effective dose (ED 50) and 95% confidence interval of propofol for painless gastroscopy were determined by the probit analysis. Results:Twenty-five patients were finally included in non-smoking group and 23 patients in heavy smoking group. The ED 50 (95% confidence interval) of ciprofol when combined with alfentanil was 0.205 (0.159, 0.244) mg/kg in non-smoking group and 0.252 (0.184, 0.295) mg/kg in heavy smoking group. The ED 50 was significantly higher in heavy smoking group than in non-smoking group ( u=390, P=0.009). Conclusions:Heavy smoking can weaken the sedative potency of propofol for sedation when used for painless gastroscopy when combined with alfentanil.

Objective:To evaluate the effect of age on the sedative potency of remimazolam.Methods:This was a prospective study. Patients of either sex, aged 40-80 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective surgery with general anesthesia, were divided into middle age group (40-64 yr) and elderly group (65-80 yr) based on the age of the patients. The test was performed by the Dixon′s up-and-down method. The initial dose of remimazolam was 0.3 mg/kg. The Modified Observer′s Assessment of Alertness/Sedation Scale score ≤1 and bispectral index value≤60 within 3 min after administration were considered as an effective sedation. The dose of remimazolam was increased/decreased by 0.03 mg/kg based on the sedative efficacy in the previous patient. The 50% effective dose (ED 50) and 95% confidence interval ( CI) of remimazolam were calculated by the probit method. The time to the loss of consciousness was recorded. Results:The ED 50 (95% CI) of remimazolam was 0.345 (0.306-0.384) mg/kg in middle age group, while the ED 50 (95% CI) of remimazolam was 0.322 (0.303-0.339) mg/kg in elderly group. The ED 50 was significantly higher in middle age group than in elderly group ( u=417.00, P=0.022). The time to loss of consciousness was significantly longer in elderly group than in middle age group ( t=-2.96, P=0.008). Conclusions:For middle-aged and elderly patients aged 40-80 yr, the sedative potency of remimazolam increases with age.

Objective:To compare the anesthetic potency of ciprofol combined with alfentanil in patients with different body mass indexes (BMIs) during gastroscopy.Methods:American Society of Anesthesiologists Physical Status classification I or Ⅱ patients, aged 18-64 yr, with a BMI of 18-36 kg/m 2, undergoing elective painless gastroscopy at Baoding First Central Hospital from October to December 2023, were divided into 3 groups: normal group (18 kg/m 2≤BMI<24 kg/m 2), overweight group (24 kg/m 2≤BMI<28 kg/m 2) and obesity group (BMI≥28 kg/m 2). The 95% effective dose (ED 95) of ciprofol during painless gastroscopy was determined by the biased coin design. Alfentanyl 5 μg/kg and ciprofol were intravenously injected for anesthesia induction. Gastroscopy was performed after the patient′s eyelash reflex disappeared, the jaw muscle was relaxed and the Modified Observer′s Assessment of Alertness/Sedation Scale score ≤ 1. The initial dose of ciprofol was 0.2 mg/kg with a dose gradient of 0.04 mg/kg. The positive response were defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score still> 1 after 3 min of ciprofol injection or any other responses affecting the procedure, such as body movement, bucking, or swallowing during insertion of the endoscope. If the response was positive, the next patient received a higher dose of ciprofol, or conversely if negative, the next patient received the same dose (95% probability) or a lower dose (5% probability). Each group was completed with 40 cases. Results:The ED 95 and 95% confidence intervals of ciprofol in normal, overweight and obese groups were 0.266 (0.246, 0.285) mg/kg, 0.218 (0.189, 0.244) mg/kg, 0.191 (0.156, 0.220) mg/kg, respectively. The ED 95 of ciprofol was significantly lower in overweight and obese groups than in normal group ( P<0.05). Conclusions:Overweight and obesity can increase the anesthetic potency of ciprofol in patients undergoing gastroscopy.

Objective:To compare the anesthetic potency of ciprofol combined with alfentanil in patients with different body mass indexes (BMIs) during gastroscopy.Methods:American Society of Anesthesiologists Physical Status classification I or Ⅱ patients, aged 18-64 yr, with a BMI of 18-36 kg/m 2, undergoing elective painless gastroscopy at Baoding First Central Hospital from October to December 2023, were divided into 3 groups: normal group (18 kg/m 2≤BMI<24 kg/m 2), overweight group (24 kg/m 2≤BMI<28 kg/m 2) and obesity group (BMI≥28 kg/m 2). The 95% effective dose (ED 95) of ciprofol during painless gastroscopy was determined by the biased coin design. Alfentanyl 5 μg/kg and ciprofol were intravenously injected for anesthesia induction. Gastroscopy was performed after the patient′s eyelash reflex disappeared, the jaw muscle was relaxed and the Modified Observer′s Assessment of Alertness/Sedation Scale score ≤ 1. The initial dose of ciprofol was 0.2 mg/kg with a dose gradient of 0.04 mg/kg. The positive response were defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score still> 1 after 3 min of ciprofol injection or any other responses affecting the procedure, such as body movement, bucking, or swallowing during insertion of the endoscope. If the response was positive, the next patient received a higher dose of ciprofol, or conversely if negative, the next patient received the same dose (95% probability) or a lower dose (5% probability). Each group was completed with 40 cases. Results:The ED 95 and 95% confidence intervals of ciprofol in normal, overweight and obese groups were 0.266 (0.246, 0.285) mg/kg, 0.218 (0.189, 0.244) mg/kg, 0.191 (0.156, 0.220) mg/kg, respectively. The ED 95 of ciprofol was significantly lower in overweight and obese groups than in normal group ( P<0.05). Conclusions:Overweight and obesity can increase the anesthetic potency of ciprofol in patients undergoing gastroscopy.

Diabetes mellitus(DM),as a common and frequently-occurring disease,has become a huge burden of chronic diseases worldwide,whose pathogenesis is very complex and has not yet been fully elucidated.Small intestine is one of important immune organ in body,and relationship between its innate immune function and DM has become forefront of research in medical field.In this paper,role of intestinal innate immunity in pathogenesis of DM is reviewed,including tissue barrier dysfunction of small intestine,dysfunction of intestinal innate immune cells and imbalance of proportion of intestinal innate immune molecules,in order to provide references for future research on related mechanisms.

Objective:To investigate the clinical characteristics, diagnosis and treatment of dermatomyositis with kidney neoplasm.Methods:The data of two patients with dermatomyositis complicated with kidney neoplasm in Tongji Hospital from January to February 2022 were retrospectively analyzed. The first case was a 55-year-old female, who was admitted with the chief complaints of recurrent erythema of upper extremities for 2 months and facial erythema for 1 month. Physical examination: erythema can be seen on upper limbs and face, no tenderness or percussion pain in kidney area. Myositis enzyme profile test showed that anti-Mi-2 antibody and anti-SSA /Ro-52 antibody were positive. Contrast CT showed nodular uneven enhancement in the right kidney with a size of 50 mm×41 mm. The second case was a 58-year-old female, who was admitted with the chief complaints of kidney occupying for a month. Physical examination: flaky erythema on face, no tenderness or percussion pain in kidney area. Myositis enzyme profile test showed that anti-Ro-52 antibody and anti-MDA5 antibody were positive. Contrast CT showed a significantly uneven enhanced mass with a size of about 50 mm×41 mm on left kidney. Both patients were diagnosed with kidney neoplasm before surgery and underwent laparoscopic partial nephrectomy in Tongji Hospital.Results:Both patients received regular oral prednisone after surgery. The pathological presentation of case 1 was papillary renal cell carcinoma, the facial erythema subsided 1 month after surgery, and there was no tumor recurrence for 13 months. The pathological presentation of case 2 was clear cell renal cell carcinoma, facial erythema subsided 2 weeks after surgery, and there was no tumor recurrence for 12 months.Conclusions:The diagnosis of dermatomyositis should be combined with clinical manifestations and laboratory examination, and the possibility of malignant tumor should be excluded due to the high likelihood of concomitant malignancy. For patients with dermatomyositis with kidney neoplasm, the main treatment is still surgery, and supplemented with glucocorticoid therapy.

Objective:To determine the median effective dose (ED 50) of ciprofol inhibiting responses to insertion of laryngeal mask airway in the patients when combined with alfentanil. Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 40-64 yr, with body mass index of 20-30 kg/m 2, undergoing elective general anesthesia, were enrolled. Midazolam 0.025 mg/kg was intravenously injected for anesthesia induction, the baseline mean arterial pressure and heart rate were recorded 5 min later, and the average value of three times was considered as the baseline value. Ciprofol and alfentanil 10 μg/kg were intravenously injected in sequence, rocuronium 0.6 mg/kg was intravenously injected when BIS value < 60, 2 min later a laryngeal mask airway was placed, and mechanical ventilation was performed. Positive response was defined as increase in the maximum mean arterial blood pressure or heart rate more than or equal to 20% of the baseline value within 3 min after placement of the laryngeal mask airway or as the occurrence of body movement, bucking, frowning, mouth and face twitching, tearing, laryngospasm or the BIS value failing to drop below 60. The study was performed by the Dixon′s up-and-down method. The initial dose of ciprofol was 0.4 mg/kg, and the ratio between the two successive doses was 1.1. If a positive response occurred, the dose was increased in the next patient, otherwise the dose was reduced. The ED 50 and 95% confidence interval of ciprofol inhibiting responses to insertion of laryngeal mask airway were calculated by the probit method. Results:The ED 50(95% confidence interval) of ciprofol inhibiting responses to insertion of laryngeal mask airway was 0.291(0.231-0.318) mg/kg when combined with alfentanil 10 μg/kg. Conclusions:The ED 50 of ciprofol inhibiting responses to insertion of laryngeal mask airway is 0.291 mg/kg in the patients when combined with alfentanil 10 μg/kg.

Objective:To investigate the current status of polypharmacy among elderly outpatients with 4 types of chronic diseases such as hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease.Methods:A retrospective study was conducted on the drug use of elderly (≥65 years old) outpatients with hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease with data of Beijing Municipal Health Insurance Centre database from July 2017 to September 2017. The included patients had at least 1 of 4 types of chronic diseases. Polypharmacy was defined as ≥5 different types of medication at the first visit, and non-polypharmacy was defined as <5 types of medication. The number and severity of comorbidity were quantified using the Charlson Comorbidity Index (CCI), and the prognosis of patient was evaluated at 4 levels of 0, 1, 2, and ≥3 scores. The larger the value, the more severe the disease. Based on the Beers Criteria 2015, the potential inappropriate medication (PIM) was identified using the prescription review system of Puhua Health.Results:A total of 405 608 patients were included in this study, with a median age of 74 (65-107) years, and 204 219 patients (50.35%) were female. According to the type of medication used by patients, they were divided into polypharmacy group (113 594 cases, 28.01%) and non-polypharmacy group (292 014 cases, 71.99%). The CCI of the polypharmacy group was significantly higher than that of the non-polypharmacy group ( P<0.001). The proportion of patients with 0, 1, 2, and ≥3 scores in the polypharmacy group was significantly higher than that of the non-polypharmacy group, and the differences were statistically significant (all P<0.001). In terms of comorbidity, the proportions of patients among the 4 types of chronic diseases were higher in the polypharmacy group than in the non-polypharmacy group ( P<0.001). In terms of concomitant diseases, the proportion of patients with hyperlipidemia, cognitive impairment, heart failure, and osteoporosis in the polypharmacy group was higher than that in the non-polypharmacy group (all P<0.001). In terms of medical treatment behaviour, the median number of medical visits was higher in the polypharmacy group than in the non-polypharmacy group [2(1,3) vs. 1(1,2), P<0.001]. In terms of evaluating the unsuitability of medication, the proportion of patients with PIM in the polypharmacy group was higher than that in the non-polypharmacy group, including repeated medication [4.60% (5 227/113 594) vs. 1.64% (4 486/292 014)], contraindications [2.97% (3 376/113 594) vs. 1.13% (3 294/292 014)], interactions [6.51% (7 399/113 594) vs. 1.94% (5 658/292 014)], and lack of indications [22.39% (25 432/113 594) vs. 13.54% (39 543/292 014)], and the differences were all significant (all P<0.001). In terms of drug use categories, the top 5 most commonly prescribed drugs in the polypharmacy group were HMG-CoA reductase inhibitors (68 318 cases, 60.14%), dihydropyridines (60 951 cases, 53.66%), angiotensin receptor antagonists(45 050 cases, 39.66%), β-receptor blockers (25 675 cases, 22.60%) and sulfonylureas (16 023 cases, 14.11%). Conclusions:Polypharmacy is common in elderly patients with hypertension, diabetes mellitus, coronary artery disease, and cerebrovascular disease. The elderly patients with polypharmacy have a worse baseline status and more problems with PIM.