Objective:To explore the effect of Simo decoction improving the low duodenal inflammation and protecting the du-odenal mucosal barrier in rats with functional dyspepsia(FD).Methods:Sixty SD rats were randomly divided into control group(10 rats)and model group(50 rats),and the modeling rats were prepared by multivariate intervention method.After successful modeling,the modeling rats were randomly divided into model group,Simo decoction high-dose,medium-dose,low-dose group and mosapride group,with 10 rats in each group.The high-dose,medium-dose,and low-dose groups of Simo decoction were ga-vage given 5.62 g/kg,2.81 g/kg,and 1.40 g/kg,respectively,and the mosapride group was gavage given 0.305 mg/kg of mosapride,and the control group and model group were gavage given the same amount of distilled water for 14 days.The body weight of rats was observed;gastric emptying rate and small bowel propulsion rate were measured;transmission electron microscopy was used to observe the morphology of duodenal epithelial cells;ELISA detected serum levels of IL-17A and IL-22;Western blot and immunohistochemis-try were used to detect the expressions of protease-activated receptor 2(PAR-2)and tight junction protein(ZO-1,claudin-1)in the duodenum.Results:Compared with the control group,the body weight,gastric emptying rate and small intestinal propulsion rate of the model group were significantly reduced(P<0.01),transmission electron microscopy showed widening of the duodenal epithelial cell space,serum IL-17A and IL-22 levels were significantly increased(P<0.01),the expression of PAR-2 in duodenal tissue was in-creased,and the expressions of ZO-1 and claudin-1 were downregulated(P<0.01).Compared with model group,the gastric emptying rate and small intestinal propulsion rate in Simo decoction high-dose,medium-dose and mosapride group were increased(P<0.05,P<0.01),the contents of IL-17A and IL-22 in serum decreased(P<0.05,P<0.01),and the expression of PAR-2 in duodenal tissues was down-regulated,the expressions of ZO-1 and claudin-1 was significantly increased(P<0.01).The low-dose group of Simo soup could improve weight loss(P<0.01),reduce IL-17A content and PAR-2 expression,and increase ZO-1 and claudin-1 expression(P<0.05,P<0.01),while the effect on other indexes was not obvious.Conclusion:Simo decoction may reduce low-grade duodenal in-flammation to repair the mucosal barrier by down-regulating the levels of IL-17A and IL-22 and the expression of PAR-2,and up-regu-lating the expression of ZO-1 and claudin-1,so as to exert the effect of FD treatment.

Objective To explore the relationship between the nutritional risk and the risk of frequent acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods The patients with acute exac-erbation of COPD(AECOPD)hospitalized in the respiratory and critical care medicine department of the First Affiliated Hospital of Xiamen University were collected and divided into the frequent acute exacerbation risk group(FE)and non-frequent exacerbation risk group(NE).The nutritional risk was evaluated by the Nutri-tional Risk Screening Scale-2002(NRS-2002)(1-2 points as no nutritional risk,3-7 points as nutritional risk).The relationship between the two was analyzed by statistics and logistic regression.Results The FE group had longer hospital stay(P<0.01)and a higher proportion of hypertension(P<0.01).In terms of in-flammatory indicators,the neutrophil to albumin ratio(P<0.01)and platelet to lymphocyte ratio(P<0.05)in the FE group were significantly increased.In the aspect of nutritional status,the NRS-2002 score in the FE group showed a higher proportion of nutritional risk population(P<0.01),meanwhile the total protein(P<0.01)and albumin(P<0.05)levels were significantly decreased.After adjusting the confounding factors such as gender,hospitalization duration,inflammatory markers and history of underlying diseases,the full fac-tor logistic regression analysis revealed that the frequent acute exacerbation risk in COPD patients with nutri-tional risk was significantly higher that in the patients with no nutritional risk[odds ratio(OR)=2.948;95%confidence interval(95%CI):1.112-7.816;P<0.05].Conclusion The COPD patients with nutritional risk in NRS-2002 scores exhibit a significantly increased risk of frequent acute exacerbation compared to those without nutritional risk.

Purpose This study aimed to explore the mucinous phenotype characteristics,key points of differenti-al diagnosis and prognosis of invasive non-mucinous adenocarcinoma(INMA)and invasive mucinous adenocarcinoma(IMA)under the WHO(2021)lung adenocarcinoma classification.Methods We retrospectively collected clinico-pathological data from 522 cases of lung adenocarcinoma,including 425 INMA(66 with mucin secretion,259 without mucin secretion)and 97 IMA.Immunohistochemical(IHC)staining using the EnVision method was performed on the mucin-secreting adenocarcinoma to assess expression of TTF-1,HNF4α,MUC1,MUC4,MUC5AC,MUC5B,and MUC6.Unsupervised clustering analysis was conducted to explore phenotypic subgroups.Results 522 patients with lung adenocarcinoma ranged from 32 to 83 years old(median:61).251 cases(48.1％)were male and 271 cases(51.9％)were female.Clustering analysis divided lung adenocarcinomas into two major groups:one characterized by TTF-1-/HNF4α+and gastric-type mucins MUC5AC+/MUC6+,predominantly IMA;the other,TTF-1+/HNF4α-/MUC4+,largely INMA.A three-marker IHC panel(TTF-1,HNF4α,MUC6)distinguished IMA from mucinous IN-MA with an area under the ROC curve(AUC)of 0.957(95％CI:0.928-0.986)and a Youden's index of 0.860.Further cluster analysis of INMA cases identified four phenotypic subgroups.Prognostic analysis demonstrated that pa-tients with advanced-stage mucin-secreting INMA had significantly shorter overall survival(OS)and progression-free survival(PFS)than those without mucin secretion(5-year OS:57.1％ vs 81.8％,P=0.004;3-year PFS:40.9％ vs 62.4％,P=0.004).No significant survival differences were noted among INMA subgroups stratified by varying mucin proportions.Multivariate analysis identified pathological stage,tumor necrosis,KRAS mutation,and TTF-1 negativity as independent adverse prognostic factors for both OS and PFS in mucinous INMA.Conclusion A three-marker im-munohistochemical panel of TTF-1,HNF4α,and MUC6 is recommended to distinguish IMA from mucinous INMA.Mucus component portends a worse prognosis in advanced INMA,with necrosis,KRAS mutations,and TTF-1 negativi-ty serving as independent adverse prognostic factors in mucinous INMA.

Objective:To explore the effect of Simo decoction improving the low duodenal inflammation and protecting the du-odenal mucosal barrier in rats with functional dyspepsia(FD).Methods:Sixty SD rats were randomly divided into control group(10 rats)and model group(50 rats),and the modeling rats were prepared by multivariate intervention method.After successful modeling,the modeling rats were randomly divided into model group,Simo decoction high-dose,medium-dose,low-dose group and mosapride group,with 10 rats in each group.The high-dose,medium-dose,and low-dose groups of Simo decoction were ga-vage given 5.62 g/kg,2.81 g/kg,and 1.40 g/kg,respectively,and the mosapride group was gavage given 0.305 mg/kg of mosapride,and the control group and model group were gavage given the same amount of distilled water for 14 days.The body weight of rats was observed;gastric emptying rate and small bowel propulsion rate were measured;transmission electron microscopy was used to observe the morphology of duodenal epithelial cells;ELISA detected serum levels of IL-17A and IL-22;Western blot and immunohistochemis-try were used to detect the expressions of protease-activated receptor 2(PAR-2)and tight junction protein(ZO-1,claudin-1)in the duodenum.Results:Compared with the control group,the body weight,gastric emptying rate and small intestinal propulsion rate of the model group were significantly reduced(P<0.01),transmission electron microscopy showed widening of the duodenal epithelial cell space,serum IL-17A and IL-22 levels were significantly increased(P<0.01),the expression of PAR-2 in duodenal tissue was in-creased,and the expressions of ZO-1 and claudin-1 were downregulated(P<0.01).Compared with model group,the gastric emptying rate and small intestinal propulsion rate in Simo decoction high-dose,medium-dose and mosapride group were increased(P<0.05,P<0.01),the contents of IL-17A and IL-22 in serum decreased(P<0.05,P<0.01),and the expression of PAR-2 in duodenal tissues was down-regulated,the expressions of ZO-1 and claudin-1 was significantly increased(P<0.01).The low-dose group of Simo soup could improve weight loss(P<0.01),reduce IL-17A content and PAR-2 expression,and increase ZO-1 and claudin-1 expression(P<0.05,P<0.01),while the effect on other indexes was not obvious.Conclusion:Simo decoction may reduce low-grade duodenal in-flammation to repair the mucosal barrier by down-regulating the levels of IL-17A and IL-22 and the expression of PAR-2,and up-regu-lating the expression of ZO-1 and claudin-1,so as to exert the effect of FD treatment.

Purpose This study aimed to explore the mucinous phenotype characteristics,key points of differenti-al diagnosis and prognosis of invasive non-mucinous adenocarcinoma(INMA)and invasive mucinous adenocarcinoma(IMA)under the WHO(2021)lung adenocarcinoma classification.Methods We retrospectively collected clinico-pathological data from 522 cases of lung adenocarcinoma,including 425 INMA(66 with mucin secretion,259 without mucin secretion)and 97 IMA.Immunohistochemical(IHC)staining using the EnVision method was performed on the mucin-secreting adenocarcinoma to assess expression of TTF-1,HNF4α,MUC1,MUC4,MUC5AC,MUC5B,and MUC6.Unsupervised clustering analysis was conducted to explore phenotypic subgroups.Results 522 patients with lung adenocarcinoma ranged from 32 to 83 years old(median:61).251 cases(48.1％)were male and 271 cases(51.9％)were female.Clustering analysis divided lung adenocarcinomas into two major groups:one characterized by TTF-1-/HNF4α+and gastric-type mucins MUC5AC+/MUC6+,predominantly IMA;the other,TTF-1+/HNF4α-/MUC4+,largely INMA.A three-marker IHC panel(TTF-1,HNF4α,MUC6)distinguished IMA from mucinous IN-MA with an area under the ROC curve(AUC)of 0.957(95％CI:0.928-0.986)and a Youden's index of 0.860.Further cluster analysis of INMA cases identified four phenotypic subgroups.Prognostic analysis demonstrated that pa-tients with advanced-stage mucin-secreting INMA had significantly shorter overall survival(OS)and progression-free survival(PFS)than those without mucin secretion(5-year OS:57.1％ vs 81.8％,P=0.004;3-year PFS:40.9％ vs 62.4％,P=0.004).No significant survival differences were noted among INMA subgroups stratified by varying mucin proportions.Multivariate analysis identified pathological stage,tumor necrosis,KRAS mutation,and TTF-1 negativity as independent adverse prognostic factors for both OS and PFS in mucinous INMA.Conclusion A three-marker im-munohistochemical panel of TTF-1,HNF4α,and MUC6 is recommended to distinguish IMA from mucinous INMA.Mucus component portends a worse prognosis in advanced INMA,with necrosis,KRAS mutations,and TTF-1 negativi-ty serving as independent adverse prognostic factors in mucinous INMA.

Objective To analyze the correlation between inflammation,nutritional indicators and hy-poproteinemia in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Meth-ods The clinical data of patients with AECOPD admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2020 to September 2022 were ret-rospectively analyzed,and the patients were divided into the hypoproteinemia group(n=73)and the non-hy-poproteinemia group(n=141)according to whether the serum albumin(ALB)was lower than 35 g/L.The clinical data,inflammatory indicators and nutritional indicators of the two groups were compared,Spearman correlation analysis was performed,and binary logistic regression analysis was performed to analyze the influ-encing factors of patients with AECOPD complicated with hypoproteinemia.Results There were statistically significant differences in age,length of hospital stay,and body weight between the two groups(P＜0.05).There were no significant differences in gender,number of hospitalizations in the past 1 year,height,diabetes,hypertension and proportion of coronary heart disease(P＞0.05).Compared with the non-hypoproteinemia group,the hypoproteinemia group had longer hospital stays and higher levels of C-reactive protein,neutrophil/albumin ratio(NAR),neutrophil to lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),and systemic immunoinflammatory index(SII).The prognostic nutritional index(PNI),body mass index(BMI),hemoglo-bin and total protein levels were lower,and the difference was statistically significant(P＜0.05).Body weight,BMI,hemoglobin,total protein,PNI and AECOPD patients with hypoproteinemia were negatively cor-related(P＜0.05),while age,length of hospital stay,C-reactive protein,NAR,NLR,PLR,SII and AECOPD patients with hypoproteinemia were positively correlated(P＜0.05).Binary logistic regression analysis showed that PNI,SII and NLR were the influencing factors of hypoproteinemia in AECOPD patients.Conclusion In clinical practice,attention should be paid to and timely correction of hypoproteinemia in pa-tients with AECOPD,improvement of inflammatory indicators and nutritional status of patients,and preven-tion of acute exacerbation.

The pathological classification and diagnostic criteria for lung neuroendocrine neoplasms (NENs) in the 2021 World Health Organization (WHO) lung tumor classification are similar to the prior classifications. However, the advances on the molecular studies of lung NENs have shown that both small cell lung carcinoma and large cell neuroendocrine carcinoma are highly heterogeneous tumors with neuroendocrine characteristics and can be subclassified based on the features of genomics or transcriptomics, which are valuable in the diagnosis of lung NENs subtypes and patient treatment. In addition, it is necessary to interpret emerging concepts such as "lung neuroendocrine tumor G3" and "histological transformation" from pathological perspectives, as well as to know the novel neuroendocrine biomarkers such as INSM1 and POU2F3. This article summarized the diagnostic changes and the advances of molecular pathology of lung NENs based on the latest WHO classification and molecular research.

Objective To observe the effects of Simo Decoction on the expressions of vasoactive intestinal peptide(VIP)and its receptor 2(VIPR2)in rats with functional dyspepsia(FD)of liver and spleen stagnation syndrome;To investigate its mechanism of action in regulating gastrointestinal motility.Methods Totally 60 SD rats were randomly divided into blank group,model group,mosapride group(0.305 mg/kg)and Simo Decoction high-,medium-and low-dosage groups(5.62,2.81,1.40 g/kg).The liver and spleen qi stagnation FD rat model was prepared by multifactorial modeling method,and the corresponding drugs were given by gavage for 14 days.The general conditions of rats in each group were observed,and body mass,gastric emptying rate and small intestine propulsion rate were measured;the histological structure of gastric antrum tissue and duodenal tissue were observed by HE staining;the positive expressions of VIP and VIPR2 in duodenal tissue were observed by immunohistochemistry;the protein and mRNA expressions of VIP and VIPR2 in duodenal tissue were detected by Western blot and RT-PCR,respectively.Results Compared with the blank group,the general condition of the rats in model group was poorer,body mass,gastric emptying rate and small intestine propulsion rate were significantly lower(P<0.01),and the protein and mRNA expressions of VIP and VIPR2 in duodenal tissue significantly increased(P<0.05,P<0.01).Compared with the model group,the body mass,gastric emptying rate and small intestine propulsion rate in Simo Decoction high-and medium-dosage groups and the mosapride group significantly increased(P<0.05,P<0.01),and the protein and mRNA expressions of VIP and VIPR2 in duodenal tissue significantly decreased(P<0.05,P<0.01).HE staining showed no significant changes in the morphology of gastric antrum and duodenum tissues.Conclusion Simo Decoction may promote gastrointestinal motility by inhibiting the expressions of VIP and VIPR2 in duodenal tissue of FD rats with liver and spleen qi stagnation,thereby improving FD.

Objective:To investigate the clinical pathologic features of high-grade squamous intraepithelial lesions (HSIL) in postmenopausal women.Methods:The clinical data of hospital patients with HSIL admitted to the Department of Gynecology of The First People's Hospital of Lianyungang, Jiangsu Province from January 2019 to December 2020 were retrospectively analyzed. Patients undergoing liquid-based thin-layer cytology, high-risk human papillomavirus (HR-HPV), colposcopy, cervical biopsy and Endocervical curettage (ECC), pathological diagnosis of HSIL, followed by cold knife conization (CKC). The diagnosis and treatment process conformed to the cervical cancer diagnosis and treatment norms, and there were a total of 594 patients with no previous cervical surgery history,including 463 cases in the premenopausal group and 131 cases in the menopausal group, and the age, contact bleeding, gynecological examination, HR-HPV, liquid-based thin layer cytology, colposcopy and biopsy results, and post-cervical cone surgery pathological results were compared and analyzed, and multivariate Logistic regression analysis was carried out for statistically different factors to identify the clinical pathological characteristics of postmenopausal HSIL patients. T-test was used for the comparison between measurement data groups with normal distribution, and rank sum test was used for the comparison between measurement data groups with non normal distribution. Counting data use χ 2 test or Fisher exact probability method. Logistic regression analysis was used in multivariate analysis. Results:There was no significant difference in the positive rate of contact bleeding (12.98%(17/131)) and HR-HPV (77.86%(102/131)) between postmenopausal group and non postmenopausal group (11.45%(53/463) and 80.56% (373/463))(χ 2 values were 0.23 and 0.46; P values were 0.632 and 0.496). The proportion of cervical columnar epithelium displacement (43.51% (57/131)) and abnormal liquid-based thin-layer cytology (87.79%(115/131)) in the postmenopausal group were lower than those in the non postmenopausal group (64.36%(298/463) and 93.74%(434/463)). There was significant difference between the two groups (χ 2 values were 18.46 and 5.16; P values were < 0.001 and 0.023). The positive rate of ECC (62.60%(82/131)), cervical type Ⅲ transformation area (73.28%(96/131)), the proportion of pathological upgrading after conization (9.92%(13/131)) and the positive rate of cutting edge after conization (24.43%(32/131)) in menopausal group were higher than those in non menopausal patients (46.22%(214/463), 26.78%(124/463), 1.73%(8/463) and 5.40%(25/463)). There were significant differences between the two groups (χ 2 values were 10.95, 94.68, 20.11 and 42.62; P values were 0.001, <0.001, <0.001 and <0.001). Multivariate Logistic regression analysis showed a high proportion of cervical type Ⅲ transformational zones ( OR=6.569, 95% CI 4.130-10.446), high ECC positivity ( OR=1.978, 95% CI 1.250-3.128), the positive rate of cone incision margins was high ( OR=4.581, 95% CI 2.386-8.794), the proportion of pathological escalation after cone surgery ( OR=4.612, 95% CI 1.557-13.668) and the proportion of smooth cervical appearance were high ( OR=0.464, 95% CI 0.294-0.731), which was the clinicopathological feature of postmenopausal HSIL ( P values were <0.001, 0.004, <0.001, 0.006 and 0.001). Conclusion:There were differences in HSIL in patients before and after menopause, clinical symptoms and screening manifestations were atypical, and lesions are easy to involve the cervical canal, the positive rate of the cut margin after coneectomy was high, and the proportion of pathological escalation was high, so more aggressive intervention should be taken for women diagnosed with precancerous cervical lesions after menopause

As for the treatment of microtia, the status quo is as follows. The ear reconstruction with autologous costal cartilage has been generally accepted as the therapeutic strategy for type Ⅲ/Ⅳ patients with only small ear lobe remaining or complete absence of auricle, and the outcomes are improved steadily with the advances in technology; but for type Ⅰ/Ⅱ patients with larger remnant ear, there is insufficient evidence to be able to support any specific treatment methods as the potential unified approach for surgeons to choose from. Non-surgical treatment with appliance wearing may play an auxiliary role in the treatment of microtia, which is worthy of further research. The authors proposed a serialized treatment system based on their clinical practice and literature review. It is expected to be helpful for the treatment of microtia.