Esophageal cancer （EC） is a highly prevalent malignant tumor in China. The phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， as one of the key oncogenic pathways， can promote the cell cycle progression， proliferation， migration， and invasion， induce chemoresistance， and inhibit apoptosis and autophagy of EC cells. Traditional Chinese medicine （TCM）， with the advantages of targeting multiple points with multiple components to delay cancer progression， can target the PI3K/Akt signaling pathway for EC treatment. This article preliminarily discusses the molecular mechanism and role of the PI3K/Akt signaling pathway in EC and elaborates on the specific targets and efficacy of TCM in treating EC through intervention in the PI3K/Akt signaling pathway in the past five years. TCM materials and extracts inhibiting the PI3K/Akt signaling pathway in EC include Borneolum， spore powder of Ganoderma lucidum without spore coat， extract of Celastrus orbiculatus， root extract of Taraxacum， and Bruceae Fructus oil emulsion. TCM active ingredients exerting the effect include flavonoids， terpenoids， saponins， phenols， polysaccharides， alkaloids， and other compounds. TCM compound prescriptions with such effect include Qige San， Huqi San， Xuanfu Daizhetang， Tongyoutang and its decomposed prescriptions， Liujunzi Tang， and Xishenzhi Formula. In addition， TCM injections such as Compound Kushen Injection and Kang'ai injection also inhibit the PI3K/Akt signaling pathway in EC. This paper summarizes the role of the PI3K/Akt signaling pathway in EC and the TCM interventions， aiming to provide reference for the research and clinical application of new drugs for EC.

Left ventricular pseudoaneurysm(LVPA) is a rare type of abnormal ventricular wall bulge formed by injury to the inner wall of the left ventricle. The exterior wall only consists of epicardium or/and pericardium. In a systematic literature review, myocardial infarction(55%), surgery(33%), and trauma(7%) are the top three associations. Being affected by the high pressure of the left ventricle, LVPA has the risk of enlargement and rupture, which can lead to sudden death. The treatment of LVPA consists of three main modalities: medication, surgery, and transcatheter closure. In the past, surgery was the preferred treatment for LVPA, but the surgery was highly invasive, traumatic, and associated with increased risks. In recent years, transcatheter closure has been developed and applied clinically with good results. The benefits of minimal invasiveness and quick recovery have emerged as a popular treatment for LVPA. Currently, the etiology, formation, and treatment of LVPA are not clearly defined. Large-sample studies and authoritative guidelines to guide the treatment are scarce. The timing, imaging modality, and access routes to LVPA for both surgery and transcatheter closure are still controversial. In this article, we review the relevant literatures and draw the following conclusions as: (1) Diagnostic workup is essential for anatomical characterization of LVPA, which is mandatory to guide the decision on surgical methods.(2) For a subset of patients with LVPA and a well-defined fibrotic neck, and deemed at high surgical risk, transcatheter closure of the cavity has been described with encouraging results.

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.

Objective:Summarize the clinical efficacy of using a disposable decomposed soft injection probe under propofol induced local infiltration anesthesia for the treatment of complex anal fistula.Methods:This technology is applied to patients with complex anal fistulas with clear diagnosis and no surgical contraindications. Using propofol to induce local infiltration anesthesia, a disposable decomposed soft injection probe (invention patent number: ZL 2014 1 0173127.3) soft catheter is gently introduced from the outer opening, passing through a cord like hard structure that can be touched on the surface of the body, and exiting through the rectum and anal canal. According to preoperative identification, each probe is explored one by one. If the inner opening and fistula are below the anorectal ring, a "V" - shaped incision is made to the skin and mucosal transition area between the inner and outer openings, and the fistula and inner opening are removed; If the exploration of the internal opening and fistula is above the anorectal ring, the internal opening should be enlarged and trimmed, and the skin of the external opening should be cut off in a shuttle shape. A soft catheter should be used to pull out a rubber strip for loose floating drainage. The two ends of the drainage rubber strip should be tied and fixed with 1 # silk thread. Connect a disposable decomposed soft injection probe with extracted methylene blue mixture (methylene blue 0.5 ml+0.9% sodium chloride 9.5 ml), press the external opening of the anal fistula to form a blind tube that seals the external opening, inject methylene blue mixture, implant an anal hook, explore the remaining blue anal sinus area, and inject methylene blue mixture again to determine the accurate position of the internal opening. Trim and enlarge the inner openings that have been accurately detected one by one. For the main fistula that runs below the anorectal ring, perform a "V" incision to cut open the soft tissue in the skin and mucosal transition area between the inner and outer openings, and remove the inner opening and fistula at once; For anal fistulas with fistulas above the anorectal ring, internal incision trimming and enlargement, sinus scraping, and floating bridge drainage surgery should be performed; For a complex anal fistula with multiple internal and external openings, the main lesion should be incised and treated with branch drainage. Record the successful time of internal port exploration, intraoperative and postoperative pain score (VAS), degree of fecal incontinence (Wexner incontinence score), wound healing time, and 3-month postoperative recurrence rate.Results:From January 2020 to December 2023, the Proctology Department of Zaozhuang Fourth Hospital and the Proctology Department of Tengzhou Traditional Chinese Medicine Hospital (Workers' Hospital) treated 54 patients with complex anal fistula using a disposable decomposed soft injection probe under propofol induced local infiltration anesthesia. The average successful internal exploration time was 2.80 minutes, and the average healing time was (22.3±2.6) days. The VAS scores (points) during surgery, 2 days after surgery, 4 days after surgery, and 6 days after surgery were 0.9±0.2, 1.5±0.2, 1.2±0.1, and 0.6±0.2, respectively. The Wexner score at 1 month after surgery was 0.80±0.20, All patients were followed up until April 2024, and the recurrence rate at 3 months after surgery was 5.6%.Conclusion:The use of disposable decomposed soft injection probes under propofol induced local infiltration anesthesia for the diagnosis and treatment of complex anal fistulas has shortened exploration and surgical time, improved treatment comfort and cure rate, and is safe and effective.

Objective:To evaluate the application effect of management mode based on constraint theory for medical equipment in equipment management of vascular surgery. Methods:Based on five-step method of constraint theory,an operation evaluation system was formulated. An information management mode of medical equipment was constructed to manage quality of medical equipment in department of vascular surgery. A total of 60 sets used medical equipment in the Department of Vascular Surgery at The Second Affiliated Hospital of Xi'an Jiaotong University from 2021 to 2022 were selected. The conventional management mode was adopted to manage these equipment between January to December 2021,while equipment was managed by using medical equipment management mode based on constraint theory (constraint theory management) of the department of vascular surgery from January to December 2022. The quality scores of operation and maintenance of equipment,average incidence rates of risk,configuration effectiveness,and timeliness of equipment management were compared between the two management modes. Results:After constraint theory management was implemented,the average scores of operation and maintenance of equipment,which included success starting-up,operation,routine maintenance and fault repair,were respectively (90.69±8.65),(89.65±4.65),(88.65±5.63),and (90.58±6.01),all of which were higher than those of conventional management mode. The differences of them between two modes were statistically significant (t=13.482,17.867,14.552,14.449,P<0.05). The average incidence rates of the risks of testing equipment,treatment,monitoring equipment and auxiliary equipment of adopting constraint theory mode management were (0.89±0.22)％,(0.84±0.23)％,(0.74±0.32)％ and (0.75±0.32％),all which were lower than those of the conventional management mode,with statistically significant differences (t=9.162,17.745,19.469,15.019,P<0.05). The average utilization rate of equipment and the average amplification of cost benefit of equipment were respectively (88.69±5.54)％ and (50.36±2.69)％ after constraint theory mode was adopted,which were significantly higher than those of conventional management mode,and the average floating rate of using equipment of constraint theory mode was (1.23±0.97)％,which was lower than that of conventional management model,the differences of them between two modes were statistically significant (t=14.174,21.564,11.811,P<0.05). The average times of emergency management for risk events included the safety of power consumption of equipment,safety of diagnosis and treatment,biological safety and radiation safety were respectively (2.36±0.64)h,(3.26±0.78)h,(4.23±1.24)h and (2.26±1.23)h after the constraint theory mode was adopted,all of which were significantly less than those of conventional management mode,and the differences of them between two modes were statistically significant (t=16.704,13.421,9.029,13.971,P<0.05). Conclusion:The application of the management mode based on the constraint theory of medical equipment in department of vascular surgery can improve the quality of operation and maintenance of equipment for safety,and shorten the emergency response time of equipment,and reduce the incidence of equipment risk,and strengthen the effect of configuration for equipment.

Objective:To evaluate the application effect of management mode based on constraint theory for medical equipment in equipment management of vascular surgery. Methods:Based on five-step method of constraint theory,an operation evaluation system was formulated. An information management mode of medical equipment was constructed to manage quality of medical equipment in department of vascular surgery. A total of 60 sets used medical equipment in the Department of Vascular Surgery at The Second Affiliated Hospital of Xi'an Jiaotong University from 2021 to 2022 were selected. The conventional management mode was adopted to manage these equipment between January to December 2021,while equipment was managed by using medical equipment management mode based on constraint theory (constraint theory management) of the department of vascular surgery from January to December 2022. The quality scores of operation and maintenance of equipment,average incidence rates of risk,configuration effectiveness,and timeliness of equipment management were compared between the two management modes. Results:After constraint theory management was implemented,the average scores of operation and maintenance of equipment,which included success starting-up,operation,routine maintenance and fault repair,were respectively (90.69±8.65),(89.65±4.65),(88.65±5.63),and (90.58±6.01),all of which were higher than those of conventional management mode. The differences of them between two modes were statistically significant (t=13.482,17.867,14.552,14.449,P<0.05). The average incidence rates of the risks of testing equipment,treatment,monitoring equipment and auxiliary equipment of adopting constraint theory mode management were (0.89±0.22)％,(0.84±0.23)％,(0.74±0.32)％ and (0.75±0.32％),all which were lower than those of the conventional management mode,with statistically significant differences (t=9.162,17.745,19.469,15.019,P<0.05). The average utilization rate of equipment and the average amplification of cost benefit of equipment were respectively (88.69±5.54)％ and (50.36±2.69)％ after constraint theory mode was adopted,which were significantly higher than those of conventional management mode,and the average floating rate of using equipment of constraint theory mode was (1.23±0.97)％,which was lower than that of conventional management model,the differences of them between two modes were statistically significant (t=14.174,21.564,11.811,P<0.05). The average times of emergency management for risk events included the safety of power consumption of equipment,safety of diagnosis and treatment,biological safety and radiation safety were respectively (2.36±0.64)h,(3.26±0.78)h,(4.23±1.24)h and (2.26±1.23)h after the constraint theory mode was adopted,all of which were significantly less than those of conventional management mode,and the differences of them between two modes were statistically significant (t=16.704,13.421,9.029,13.971,P<0.05). Conclusion:The application of the management mode based on the constraint theory of medical equipment in department of vascular surgery can improve the quality of operation and maintenance of equipment for safety,and shorten the emergency response time of equipment,and reduce the incidence of equipment risk,and strengthen the effect of configuration for equipment.

Objective:Summarize the clinical efficacy of using a disposable decomposed soft injection probe under propofol induced local infiltration anesthesia for the treatment of complex anal fistula.Methods:This technology is applied to patients with complex anal fistulas with clear diagnosis and no surgical contraindications. Using propofol to induce local infiltration anesthesia, a disposable decomposed soft injection probe (invention patent number: ZL 2014 1 0173127.3) soft catheter is gently introduced from the outer opening, passing through a cord like hard structure that can be touched on the surface of the body, and exiting through the rectum and anal canal. According to preoperative identification, each probe is explored one by one. If the inner opening and fistula are below the anorectal ring, a "V" - shaped incision is made to the skin and mucosal transition area between the inner and outer openings, and the fistula and inner opening are removed; If the exploration of the internal opening and fistula is above the anorectal ring, the internal opening should be enlarged and trimmed, and the skin of the external opening should be cut off in a shuttle shape. A soft catheter should be used to pull out a rubber strip for loose floating drainage. The two ends of the drainage rubber strip should be tied and fixed with 1 # silk thread. Connect a disposable decomposed soft injection probe with extracted methylene blue mixture (methylene blue 0.5 ml+0.9% sodium chloride 9.5 ml), press the external opening of the anal fistula to form a blind tube that seals the external opening, inject methylene blue mixture, implant an anal hook, explore the remaining blue anal sinus area, and inject methylene blue mixture again to determine the accurate position of the internal opening. Trim and enlarge the inner openings that have been accurately detected one by one. For the main fistula that runs below the anorectal ring, perform a "V" incision to cut open the soft tissue in the skin and mucosal transition area between the inner and outer openings, and remove the inner opening and fistula at once; For anal fistulas with fistulas above the anorectal ring, internal incision trimming and enlargement, sinus scraping, and floating bridge drainage surgery should be performed; For a complex anal fistula with multiple internal and external openings, the main lesion should be incised and treated with branch drainage. Record the successful time of internal port exploration, intraoperative and postoperative pain score (VAS), degree of fecal incontinence (Wexner incontinence score), wound healing time, and 3-month postoperative recurrence rate.Results:From January 2020 to December 2023, the Proctology Department of Zaozhuang Fourth Hospital and the Proctology Department of Tengzhou Traditional Chinese Medicine Hospital (Workers' Hospital) treated 54 patients with complex anal fistula using a disposable decomposed soft injection probe under propofol induced local infiltration anesthesia. The average successful internal exploration time was 2.80 minutes, and the average healing time was (22.3±2.6) days. The VAS scores (points) during surgery, 2 days after surgery, 4 days after surgery, and 6 days after surgery were 0.9±0.2, 1.5±0.2, 1.2±0.1, and 0.6±0.2, respectively. The Wexner score at 1 month after surgery was 0.80±0.20, All patients were followed up until April 2024, and the recurrence rate at 3 months after surgery was 5.6%.Conclusion:The use of disposable decomposed soft injection probes under propofol induced local infiltration anesthesia for the diagnosis and treatment of complex anal fistulas has shortened exploration and surgical time, improved treatment comfort and cure rate, and is safe and effective.

Left ventricular pseudoaneurysm(LVPA) is a rare type of abnormal ventricular wall bulge formed by injury to the inner wall of the left ventricle. The exterior wall only consists of epicardium or/and pericardium. In a systematic literature review, myocardial infarction(55%), surgery(33%), and trauma(7%) are the top three associations. Being affected by the high pressure of the left ventricle, LVPA has the risk of enlargement and rupture, which can lead to sudden death. The treatment of LVPA consists of three main modalities: medication, surgery, and transcatheter closure. In the past, surgery was the preferred treatment for LVPA, but the surgery was highly invasive, traumatic, and associated with increased risks. In recent years, transcatheter closure has been developed and applied clinically with good results. The benefits of minimal invasiveness and quick recovery have emerged as a popular treatment for LVPA. Currently, the etiology, formation, and treatment of LVPA are not clearly defined. Large-sample studies and authoritative guidelines to guide the treatment are scarce. The timing, imaging modality, and access routes to LVPA for both surgery and transcatheter closure are still controversial. In this article, we review the relevant literatures and draw the following conclusions as: (1) Diagnostic workup is essential for anatomical characterization of LVPA, which is mandatory to guide the decision on surgical methods.(2) For a subset of patients with LVPA and a well-defined fibrotic neck, and deemed at high surgical risk, transcatheter closure of the cavity has been described with encouraging results.

Objective:To develop a clinical automated diagnostic system for temporomandibular disor-ders(TMD)based on the diagnostic criteria for TMD(DC/TMD)to assist dentists in making rapid and accurate clinical diagnosis of TMD.Methods:Clinical and imaging data of 354 patients,who visited the Center for TMD & Orofacial Pain at Peking University Hospital of Stomatology from September 2023 to January 2024,were retrospectively collected.The study developed a clinical automated diagnostic system for TMD using the DC/TMD,built on the.NET Framework platform with branching statements as its in-ternal structure.Further validation of the system on consistency and diagnostic efficacy compared with DC/TMD were also explored.Diagnostic efficacy of the TMD clinical automated diagnostic system for de-generative joint diseases,disc displacement with reduction,disc displacements without reduction with limited mouth opening and disc displacement without reduction without limited mouth opening was evalua-ted and compared with a specialist in the field of TMD.Accuracy,precision,specificity and the Kappa value were assessed between the TMD clinical automated diagnostic system and the specialist.Results:Diagnoses for various TMD subtypes,including pain-related TMD(arthralgia,myalgia,headache attribu-ted to TMD)and intra-articular TMD(disc displacement with reduction,disc displacement with reduc-tion with intermittent locking,disc displacement without reduction with limited opening,disc displace-ment without reduction without limited opening,degenerative joint disease and subluxation),using the TMD clinical automated diagnostic system were completely identical to those obtained by the TMD spe-cialist based on DC/TMD.Both the system and the expert showed low sensitivity for diagnosing degenera-tive joint disease(0.24 and 0.37,respectively),but high specificity(0.96).Both methods achieved high accuracy(＞0.9)for diagnosing disc displacements with reduction and disc displacements without reduction with limited mouth opening.The sensitivity for diagnosing disc displacement without reduction without limited mouth opening was only 0.59 using the automated system,lower than the expert(0.87),while both had high specificity(0.92).The Kappa values for most TMD subtypes were close to 1,ex-cept the disc displacement without reduction without limited mouth opening,which had a Kappa value of 0.68.Conclusion:This study developed and validated a reliable clinical automated diagnostic system for TMD based on DC/TMD.The system is designed to facilitate the rapid and accurate diagnosis and classi-fication of TMD,and is expected to be an important tool in clinical scenarios.