ObjectiveTo observe the antidepressant effect of Chaihu Shugansan combined with ferulic acid on the rat model of chronic unpredictable mild stress （CUMS） and explore the mechanism from the histomorphology of frontal cortex， expression of key molecules in the brain-derived neurotrophic factor （BDNF）/tyrosine kinase receptor B （TrkB） signaling pathway， and changes in monoamine neurotransmitter levels. MethodsSixty adult male SD rats were randomized into six groups （n=10）： blank control， depression model， Chaihu Shugansan （3.3 g·kg^-1·d^-1）， ferulic acid （50 mg·kg^-1·d^-1）， Chaihu Shugansan （3.3 g·kg^-1·d^-1） + ferulic acid （50 mg·kg^-1·d^-1）， and fluoxetine （2.1 mg·kg^-1·d^-1）. Rats in other groups except the blank control group were subjected to a mild chronic unpredictable stress stimulus every day. Seven stimuli were used， including fasting with free access to water for 24 h， water deprivation with free access to food for 24 h， wetting the bedding with water in the cage， restraint for 3 h， tail clamping for 1 min， swimming in ice water at 4 ℃， and day and night reversal. Each stimulus was used 1 to 3 times， and the modeling lasted for a total of 21 days. At the same time of stimulation， rats in each medication group were treated with corresponding agents by gavage， while those in the blank control group and the depression model group received equal volumes of normal saline by gavage. The open field test， sucrose preference test， and forced swimming test were conducted before and after modeling. The rats were anesthetized by intraperitoneal injection of 3% pentobarbital sodium， and the frontal cortex was isolated on ice. The mRNA and protein levels of BDNF， TrkB， and cyclic adenosine monophosphate-responsive element-binding protein （CREB） in the frontal cortex were determined by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. The levels of monoamine neurotransmitters 5-hydroxytryptamine （5-HT）， dopamine （DA）， and norepinephrine （NE） in the frontal cortex were determined by enzyme-linked immunosorbent assay. Light microscopy was employed to observe the histopathological changes in the frontal cortex. ResultsCompared with the blank control group， the depression model group showed reduced body mass （P<0.05， P<0.01）， decreased number of crossings and rearings in the open field test and sucrose preference （P<0.01）， prolonged time of immobility in the forced swimming test （P<0.01）， reduced neuronal cells， increased necrotic cells， and darkening cell staining in the frontal cortex， down-regulated mRNA and protein levels of BDNF， TrkB， CREB， and lowered levels of 5-HT， NE， and DA in the frontal cortex （P<0.01）. Compared with the depression model group， each intervention group showed improved general state， increased body mass （P<0.05）， increased number of crossings （P<0.05）， shortened immobility time in the forced swimming test （P<0.01）， increased neuronal cells， reduced necrotic cells， and lightened cellular staining in the frontal cortex， up-regulated mRNA and protein levels of BDNF， TrkB and CREB， and elevated levels of 5-HT， NE， and DA in the frontal cortex （P<0.01）. Moreover， the Chaihu Shugansan + ferulic acid group outperformed the Chaihu Shugansan group and the ferulic acid group in increasing the body mass and the 5-HT content in the frontal cortex （P<0.05）. The combination group outperformed the Chaihu Shugansan group regarding the number of rearings and up-regulation in the mRNA level of BDNF in the frontal cortex （P<0.05）， and it was superior to the ferulic acid group in terms of shortening the immobility time in the forced swimming test， up-regulating the mRNA levels of BDNF， TrkB， and CREB and the protein levels of BDNF and CREB in the frontal cortex， and increasing the DA content in the frontal cortex （P<0.05）. ConclusionChaihu Shugansan combined with ferulic acid can exert antidepressant effect on the rat model of CUMS by regulating the BDNF/TrkB signaling pathway and monoamine neurotransmitter content in the frontal cortex. Moreover， the antidepressant effect of Chaihu Shugansan combined with ferulic acid was more significant than that of Chaihu Shugansan and ferulic acid used alone.

Based on the trinity life view of ''physique， Qi， and spirit''， Chaihu Jia Longgu Mulitang treats the patient's physical symptoms， disorders of Qi movement， and disorders of consciousness， covering the overall treatment and comprehensive nursing of physique， Qi， and spirit. It is widely applied and recognized for its efficacy in modern clinical practice. This paper explored the treatment effect of Chaihu Jia Longgu Mulitang from the trinity life view of ''physique， Qi， and spirit''. This formula mainly targeted patients with Qi deficiency caused by cold， leading to a syndrome of Qi stagnation and water retention in the Triple Energizer Meridian of Hand Lesser Yang （TE）， as well as fire-heat syndrome in the Large Intestine Meridian of Hand Yang Brightness （LI） and Stomach Meridian of Foot Yang Brightness （ST）， accompanied by disorder of nutrient-blood and subsequent spirit and soul unrest. Accurately judging the imbalance of the patient's physique， Qi， and spirit and using an appropriate combination of medicinals can achieve balance among the three to achieve the best effect. The treatment strategy of Chaihu Jia Longgu Mulitang is as follows： For disorders of Qi movement， such as Qi deficiency， Qi stagnation， and gastrointestinal fire-heat， Ginseng Radix et Rhizoma and Bupleuri Radix-Scutellariae Radix， and Rhei Radix et Rhizoma are used in combination. For physical symptoms such as water retention and disorder of nutrient-blood， Poria-Pinelliae Rhizoma-Zingiberis Rhizoma Recens， as well as Cinnamomi Ramulus-Jujubae Fructus are used in combination. Finally， Os Draconis-Ostreae Concha-Plumbum Rubrum is used to calm the spirit and soothe the soul. According to existing research， Chaihu Jia Longgu Mulitang has shown good efficacy in treating a variety of complex clinical diseases. This article provides a comprehensive interpretation of Chaihu Jia Longgu Mulitang from the perspective of the trinity life view of ''physique， Qi， and spirit''， offering new insights for clinical syndrome differentiation， treatment， and prescription.

Phantom limb pain (PLP) is a form of neuropathic pain occurring after limb amputation, and its underlying mechanisms remain unclear, posing significant challenges for clinical management. Spinal cord stimulation (SCS), a neuromodulation technique, has shown potential in relieving chronic pain, though its long-term efficacy and safety in treating PLP require further validation. This report presents a case of a 42-year-old male experiencing persistent radiating, lightning-like pain [Visual Analog Scale (VAS) score 8-9], following right upper limb amputation. Preoperative imaging revealed signal loss in the right nerve roots at C₆-T₁. A percutaneous electrode was implanted surgically to achieve full coverage of the painful region. Five days postoperatively, the VAS score dropped to 2-3, and after 1 year of follow-up, the patient continued to experience significant pain relief (VAS 1-2), with complete resolution of depressive symptoms and cessation of analgesic medication. Existing studies suggest that the long-term outcomes of SCS may fluctuate, and attention should be paid to potential complications such as infection and electrode displacement.
Humans ; Phantom Limb/therapy* ; Male ; Adult ; Spinal Cord Stimulation/methods* ; Electrodes, Implanted ; Amputation, Surgical/adverse effects*

Five novel nor-eremophilane-type sesquiterpenoids, peniroqueforins E-H and J (1-4 and 7), two new eremophilane-type sesquiterpenoids, peniroqueforins I and K (5 and 8), and a new eudesmane-type sesquiterpenoid, peniroqueforin L (9), along with four known compounds (6 and 10-12), were isolated and characterized from fungus Penicillium roqueforti (P. roqueforti). The structures and absolute configurations of these compounds were determined through comprehensive spectroscopic analyses, electronic circular dichroism (ECD) data analyses, and single-crystal X-ray diffraction methods. The anti-multi-drug resistance (MDR) cancer activity of these compounds was evaluated using SW620/Ad300 cells. Notably, the half maximal inhibitory concentration (IC₅₀) value of paclitaxel (PTX) combined with 1 in SW620/Ad300 cells was 50.36 nmol·L^-1, which was 65-fold more potent than PTX alone (IC₅₀ 3.26 μmol·L^-1). Subsequent molecular docking studies revealed an affinity between compound 1 and P-glycoprotein (P-gp), suggesting that this nor-eremophilane-type sesquiterpenoid (1) could serve as a potential lead for MDR reversal in cancer cells through P-gp inhibition.
Penicillium/chemistry* ; Humans ; Sesquiterpenes/isolation & purification* ; Cell Line, Tumor ; Molecular Structure ; Drug Resistance, Neoplasm/drug effects* ; Antineoplastic Agents/pharmacology* ; Drug Resistance, Multiple/drug effects* ; Molecular Docking Simulation

Operation management is an important tool to promote the high-quality development of public hospitals in China.Since the founding of New China,based on China's economic and social development and medical and health system reform,the evolution of operation management of public hospitals in China can be divided into four stages,the system building stage(1949-1978),the liberalization and revitalization stage(1979-1996),the operation mechanism reform stage(1997-2020),and the new stage of high-quality development(2021 present).The development trend of public hospital operation management in future should deepen the public welfare-oriented public hospital operation management,explore the value-oriented medical operation management model based on high-quality development and the refined operation and management model of public hospitals,so as to promote the high-quality development of public hospitals in China.

Objective To explore the therapeutic effect of flexible ureteroscopic lithotripsy(FURL)by using flexible ureteroscope combined with flexible vacuum suction ureteral access sheath in the treatment of renal calculi with diameter 3-4.5 cm and CT value≤1000 HU.Methods A Retrospective analysis was conducted on clinical data of 42 patients with 3-4.5 cm renal calculi and CT value≤1000 HU from March 2023 to March 2025.A disposable flexible ureteroscope combined with flexible vacuum suction ureteral access sheath was used to fragment the calculi with holmium laser,and the fragments were then aspirated.Results Two cases had their stones left untreated when the operation time exceeded 2.5 h,resulting in the termination of the surgery.The remaining40 cases were successfully treated with the operation.The operation time was 85-150 min,with an average of(113.9±17.8)min.The postoperative hospital stay was2-5 d,with an average of(2.2±0.6)d.Postoperative fever occurred in 2 cases,and hematuria appeared in 5 cases,all of which were cured by conservative treatment.On the first postoperative day,residual stones were found in 4 cases.At 1 month after surgery,residual stones were detected in 3 cases.One case was treated with extracorporeal shock wave lithotripsy(ESWL)and the stones were expelled after 1 month.The other 2 cases(those whose surgery was terminated)underwent a second FURL and achieved successful stone clearance.Conclusion FURL for 3-4.5 cm renal calculi with CT value≤1000 HU by using flexible ureteroscope combined with flexible vacuum suction ureteral access sheath is safe and effective.

Objective To explore the effect of bone grafting combined with locking plate fixation on the postoperative rehabilitation of patients with comminuted proximal humerus fractures.Methods A total of 84 patients with comminuted proximal humerus fractures who underwent surgery at Armed Forces Jiangxi General Hospital from January 2022 to July 2024 were enrolled.Using a randomized digital table method,the patients were divided into conventional group(n=42)and combined group(n=42).The combined group received bone grafting combined with locking plate fixation,while conventional group underwent single locked plate internal fixation.Perioperative indicators,shoulder joint function,range of motion,quality of life,and complications were compared between two groups.Results Compared with conventional group,intraoperative blood loss,surgical duration were longer while fracture healing time and hospitalization period were shorter in combined group,as well as postoperative drainage volume was lower(P＜0.05).Shoulder joint function of combined group was better than that of conventional group(P＜0.05).At 3 months after surgery,the short form health survey(SF-36)scores of patients in both groups were higher than those before surgery,and the SF-36 score of combined group was higher than that of conventional group(P＜0.05).The total incidence of complications in combined group was lower than that in conventional group,and the difference was statistically significant(P＜0.05).Conclusion Bone grafting combined with locking plate fixation for comminuted proximal humerus fractures is more safe,can shorten hospitalization time and fracture healing time,promote shoulder joint function improvement,improve patients' shoulder joint activity and quality of life.

Objective:To explore the clinical characteristics and risk factors of acute kidney injury (AKI) in patients with diquat mixed with paraquat poisoning.Methods:We retrospectively analyzed the clinical data of 210 patients admitted to the department of emergency at our hospital with paraquat, diquat or mixed poisoning from January 20, 2016, to June 10, 2024. Based on the detection results of plasma toxicants, patients were categorized into three groups: the paraquat group (PQ group), and the diquat group (DQ group), the diquat-paraquat mixed group (mixed group). We compared clinical indices, occurrence, and severity of AKI among these groups. In the mixed group, patients were further divided into AKI and non-AKI subgroups based on the presence of AKI during hospitalization, and differences in clinical indices between these subgroups were analyzed. Univariate logistic regression and least absolute shrinkage and selection operator (Lasso) regressions were used to screen risk factors, and multivariate logistic regression was applied to establish the model. ROC curves were generated, and factors influencing AKI occurrence in the mixed group were identified.Results:A total of 88 patients were included in the PQ group, 28 in the DQ group, and 57 in the mixed group. Significant differences were observed among the three groups in terms of age, mortality rate, ingestion amount, body mass index(BMI), occurrence of AKI, the incidence of organ support therapy, SIRS score, PSS score, and APACHE Ⅱ score on admission ( P < 0.05). All three groups exhibited various degrees of AKI, with the mixed group showing a higher proportion and more severe conditions. In the mixed group, compared with the non-AKI group, the AKI group showed significantly higher values for age, number of deaths, ingestion amount, SIRS score, PSS score, APACHE Ⅱ score, plasma PQ concentration on admission, plasma DQ concentration on admission, white blood cell count (WBC), neutrophil count (NEUT), monocyte count (MONO), serum creatinine (SCr), procalcitonin (PCT), c-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood lactic acid (Lac), and cystatin C (CysC) ( P < 0.05). Conversely, the estimated glomerular filtration rate (eGFR) and partial pressure of carbon dioxide (PCO2) were significantly lower in the AKI group ( P < 0.05). Additionally, in the mixed group, SCr levels at various times post-poisoning were significantly higher compared with the non-AKI group ( P < 0.05), showing an increasing trend and peaking at 212.19 ± 101.67 μmol/L on the fifth day after poisoning. Age, ingestion amount, SIRS score on admission, WBC, MONO, and PCO 2 were extracted by Lasso-Logistic regression. Multivariate logistic regression identified ingestion amount and SIRS score on admission as the independent risk factors for the occurrence of AKI in the mixed group. The area under the ROC curve for ingestion amount and SIRS score on admission was 0.991 (95% CI: 0.976-1.000), the sensitivity was 0.940 and the specificity was 1.000. Conclusions:The diquat mixed with paraquat poisoning is associated with a higher incidence and greater severity of AKI compared with poisoning with either PQ or DQ alone. Additionally, ingestion amount and SIRS score on admission have been identified as independent risk factors for the occurrence of AKI in patients with the mixed poisoning. The combined assessment of these two factors improves AKI prediction in patients with the mixed poisoning.

[Objective] To evaluate the efficacy and safety of sacral neuromodulation (SNM) in the treatment of patients with benign prostatic hyperplasia (BPH) complicated with underactive bladder (UAB) who respond poorly to transurethral resection of the prostate (TURP). [Methods] A retrospective analysis was performed on 10 patients with BPH and UAB treated with TURP by the same surgeon in Zhongda Hospital Southeast University during Jan.2018 and Jan.2023.The residual urine volume was not significantly relieved after operation, and the maximum urine flow rate and urine volume per discharge were not significantly improved.All patients underwent phase I SNM, and urinary diaries were recorded before and after surgery to observe the average daily frequency of urination, volume per urination, maximum urine flow rate, and residual urine volume. [Results] The operation time was (97.6±11.2) min.During the postoperative test of 2-4 weeks, if the residual urine volume reduction by more than 50% was deemed as effective, SNM was effective in 6 patients (60.0%). Compared with preoperative results, the daily frequency of urination [(20.2±3.8) times vs. (13.2±3.2) times], volume per urination [(119.2±56.7) mL vs. (246.5±59.2) mL], maximum urine flow rate [(8.7±1.5) mL/s vs. (16.5±2.6) mL/s], and residual urine volume [(222.5±55.0) mL vs. (80.8±16.0) mL] were significantly improved, with statistical significance (P<0.05). There were no complications such as bleeding, infection, fever or pain.The 6 patients who had effective outcomes successfully completed phase II surgery, and the fistula was removed.During the follow-up of 1 year, the curative effect was stable, and there were no complications such as electrode displacement, incision infection, or pain in the irritation sites.The residual urine volume of the other 4 unsuccessful patients did not improve significantly, and the electrodes were removed and the vesicostomy tube was retained. [Conclusion] SNM is safe and effective in the treatment of BPH with UAB patients with poor curative effects after TURP.

Objective To evaluate the efficacy and safety of using stent semi-retrieval technique during mechanical thrombectomy(MT)for acute anterior cerebral artery(ACA)occlusion.Methods We made a retrospective analysis of 38 patients with acute ACA occlusion treated by stent semi-retrieval technique at Tangdu Hospital and Xi'an No.1 Hospital from June 2019 to September 2023.The successful recanalization,first-pass effect(FPE),perioperative complications and postoperative recovery of all the patients were analyzed.Modified thrombolytic test in cerebral infarction(mTICI)was used to evaluate the recanalization(unsuccessful recanalization,mTICI 0-2a;successful recanalization,mTICI 2b-3).FPE was defined as mTICI 3 after one thrombectomy.The clinical outcome was evaluated by modified Rankin Scale(mRS)3 months postoperatively.A good prognosis was defined as a mRS 0-2.Results Of the 38 patients,36(94.7％)got successful recanalization(mTICI 2b-3),with an FPE of 73.7％(28/38).Two cases of mild vascular spasm(5.3％)occurred during the mechanical thrombectomy,which completely relieved without further treatment.None of the 38 patients experienced vascular rupture or dissection,and no thrombus escaped during the thrombus removal process.There was no subarachnoid hemorrhage or parenchymal hemorrhage in the area related to ACA occlusion.Ninety days after operation,14 cases(36.8％)reached good outcome(mRS 0-2),18 cases(47.4％)reached mRS 3-5,and 6 cases(15.8％)died.Conclusion Our preliminary experience suggests that the stent semi-retrieval technique may be a safe and effective method for treating acute anterior cerebral artery occlusion.