This paper summarized Professor XU Jingfan's clinical experience of using Zisu （Perillafrutescens） for the treatment of spleen and stomach diseases. According to the disease characteristics， Professor XU flexibly selected the different parts of Zisu. It is believed that the leaf of Zisu is good at dispersing， dredging qi movement， and good at treating external contraction as well as internal damage due to depression or stagnation， and being effective in relieving abdominal lumps and fullness with vomiting； its stem is good at widering chest and diaphragm， smoothing qi and the middle， and dredging the twelve meridians， which can treat qi stagnation， especially suitable for distention and fullness in the midline of body like throat， esophagus， and stomach. Perilla seed is good at depressing qi and eliminating phlegm， loosening bowels to relieve constipation， which can be used in diseases of combined phlegm and qi， and combined treatment of lung and intestines to treat long-term constipation. In clinic， Huanglian （Coptis chinensis）- Zisu leaf is often used as pungent dispersing and bitter descending， promoting qi movement to treat persistent nausea and vomiting； Xiangfu （Cyperi Rhizoma）-Zisu stem is employed as regulating qi to smooth the middle， soothing qi to disperse liver stagnation for various syndromes of qi stagnation； Huomaren （Cannabis Fructus）-Zisu seed is utilized to clear the lungs and benefit qi， and moisten intestines by purgation for chronic constipation. The original ancient formulas are flexibly modified and tailored， so usually modified Banxia Houpo Decoction （半夏厚朴汤） is used to treat plum-stone qi （globus hystericus） and esophageal disorders， while modified Buzhong Yiqi Decoction （补中益气汤） combined with Xiangsu Powder （香苏散） is used to treat gastroptosis， then self-prescribed Jixing Tuxie Formula （急性吐泻方） is used for acute diarrhea， and Xiexie Waizhi Formula （泄泻外治方） is applied for chronic cold-dampness diarrhea.

Objective To explore the effects of combined exposure to bisphenol A (BPA) and high-fat diet on liver lipid metabolism and hepatocyte senescence in mice, and to elucidate the potential mechanisms of the onset and development of non-alcoholic fatty liver disease (NAFLD). Methods Specific pathogen free C57BL/6J mice were randomly divided into six groups, with 10 mice with equal numbers of each sex in each group. The mice in the control group and the simple BPA group were fed with regular diet, while others four groups of mice were fed with high-fat diet. At the same time, the mice in the simple BPA group were intragastric administered with BPA at a dose of 50 μg/kg body weight, while the mice in the low-, medium- and high-dose BPA+high-fat groups were intragastric administered with BPA at doses of 5, 50 and 500 μg/kg body weight respectively. The mice in the control group and the high-fat group were intragastric administered with the same volume of corn oil once per day for 90 consecutive days. Liver tissues were subjected to hematoxylin-eosin (HE) and Oil Red O staining. Liver coefficients and lipid-stained area ratios were calculated. Serum level of total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and the activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined using an automatic biochemical analyzer. The hepatic tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-10 levels were quantified by enzyme-linked immunosorbent assay. The relative expression of cholesterol regulatory element binding protein 1 (SREBP1), CCAAT enhancer binding protein α, P16, and phosphorylated histone H2AX (γ-H2AX) in liver tissues was detected using Western blotting. The interaction effect of the combined exposure to BPA and high-fat diet was observed based on the result of mice in the control group, the simple high-fat group, the simple BPA group, and the medium-dose BPA group+high-fat group (the combined exposure group) using a 2×2 factorial design. The results of mice in the simple high-fat group and the low-, medium-, and high-dose BPA+high-fat groups were used to observe the effect of BPA exposure dose under high-fat diet conditions. Results i) The interactive effect of combined exposure to BPA and high fat. The HE and Oil Red O staining results indicated that the combined exposure to BPA and high-fat diet successfully established NAFLD in mice. The interactive effect of combined exposure to BPA and high-fat diet on serum ALT activity and the relative expression of P16 in the liver tissue of female mice, as well as the serum ALT and AST activities and the relative expression of SREBP1 in the liver tissue of male mice was significant (all P<0.05). Specifically, the serum ALT activity of male mice in the combined exposure group was higher than that in the simple high-fat group (P<0.05), while the ALT activity in the serum of female mice in the combined exposure group was lower than that in the simple BPA group (P<0.05). The relative expression of SREBP1 protein in the liver tissue of male mice in the combined exposure group was higher than that in the control group, the simple high-fat group, and the simple BPA group (all P<0.05). For the other indicators, there were no significant differences in the interactive effect of combined exposure to BPA and high-fat diet (all P>0.05). ii) Dose effects of BPA exposure. The HE and Oil Red O staining result showed that the degree of vacuolar steatosis in the liver of female and male mice of medium- and high-dose BPA + high-fat groups was aggravated, and the range of inflammatory cell infiltration was expanded when compared with same-sex mice in the simple high-fat group. The serum ALT activity and the fat stained area ratio, as well as the relative expression of P16 in liver tissue of female mice in high-dose BPA + high-fat group increased (all P<0.05), while the level of IL-10 in liver tissue decreased (P<0.05), compared with the female mice in simple high-fat group. The serum ALT activity, the TNF-α level in liver tissue, and the relative expression of SREBP1, P16 and γ-H2AX proteins in liver tissue of male mice in high-dose BPA + high-fat group increased (all P<0.05), while the IL-6 level in liver tissue decreased (P<0.05), compared with the male mice in simple high-fat group. For the female or male mice in the low- and medium-dose BPA + high-fat groups, only some of the above indicators showed significant changes (all P<0.05). Conclusion The combined exposure to BPA and high-fat diet has a synergistic effect on the onset and development of NAFLD. The mechanism may be related to inducing cellular senescence and modulation of lipid synthesis pathways, thereby affecting liver steatosis. The exposure dose of BPA may affect the synergistic effect.

Objective: To investigate the incidence trend of diabetes among children and adolescents in Ningbo City, Zhejiang Province from 2011 to 2021, so as to provide the basis for the prevention and control of diabetes among children and adolescents. Methods: Data on diabetes incidence among children and adolescents aged 0 to 18 years in Ningbo City were collected through the Diabetes Monitoring Platform of the Ningbo Chronic Disease Collaborative Management System from 2011 to 2021. Crude incidence rates were calculated and standardized using data from the Sixth National Population Census in 2010. The trend of incidence rates were analyzed by average annual percent change (AAPC). Results: A total of 701 cases of diabetes among children and adolescents were reported in Ningbo City from 2011 to 2021. The crude and standardized incidence rates were 6.86/105 and 7.27/105, respectively, showing upward trends (AAPC=5.886%, 7.147%, both P<0.05). The crude and standardized incidence rates of type 1 diabetes mellitus were 3.36/105 and 3.35/105, respectively, with no significant trend observed (AAPC=1.229%, 1.449%, both P>0.05). The crude incidence rate was higher in children and adolescents aged 10 to <15 years (4.56/105) than in other age groups (all P<0.05). The standardized incidence rate was higher in females than in males (3.49/105 vs. 3.04/105, P<0.05). The standardized incidence rate was higher in urban areas than in rural areas (3.60/105 vs. 3.15/105, P<0.05). The crude and standardized incidence rates of type 2 diabetes mellitus were 3.43/105 and 3.87/105, respectively, showing upward trends (AAPC=4.904%, 7.579%, both P<0.05). The crude incidence rate was higher in children and adolescents aged 15 to 18 years (10.53/105) than in other groups (all P<0.05). The crude incidence rates in children and adolescents who aged 10 to <15 years and 15 to 18 years showed upward trends (AAPC=15.030%, 6.637%, both P<0.05). The standardized incidence rate was higher in males than in females (4.01/105 vs. 3.57/105, P<0.05). The standardized incidence rate was higher in urban areas than in rural areas (4.57/105 vs. 3.34/105, P<0.05). Conclusions From 2011 to 2021, the incidence of type 2 diabetes mellitus showed an upward trend, with cases mainly concentrated in children and adolescents aged 15 to 18 years, males, and those living in urban areas. The incidence of type 1 diabetes mellitus remained stable, with cases mainly concentrated in children and adolescents aged 10 to <15 years, females, and those living in urban areas.

Objective:To evaluate the application value of extended latissimusdorsi musculocutaneous flap combined with breast precision hand in stage Ⅰ breast reconstruction.Methods:Twelve cases of extended latissimusdorsi musculocutaneous flap combined with stage Ⅰ breast reconstruction for breast cancer precision surgery were collected from January 2022 to February 2023 in our department, the postoperative complications of surgical techniques were analyzed, and the cosmetic effects of breast reconstruction were evaluated according to Harris standards.Results:All 12 cases underwent breast reconstruction with extended latissimusdorsi musculocutaneous flap, and the survival rate of the flap was 100%. There was local cutaneous margin necrosis in 1 case of back incision, partial ischemic necrosis of the nipple in 1 case, and effusion in the donor area of the back in 5 cases. Harris evaluation of cosmetic effect of breast reconstruction was excellent in 3 cases, good in 6 cases, and fair in 3 cases. Follow-up time was 4-16 months (median was 12 months), and no local recurrence or distant metastasis was observed during follow-up.Conclusions:The extended latissimusdorsi musculocutaneous flap combined with precision mastectomy stage Ⅰ reconstruction is a safe and feasible treatment method for breast cancer.

AIM: To investigate the neuroprotective effect of ginsenoside Rg1 on rats with ischemic stroke and to investigate its mechanism of action. METHODS: Eighty-four SPF-grade SD male rats at about 13 weeks of age were randomly divided into 7 groups (n=12): sham-operated group, model group, Rg1 low-dose group, Rg1 medium-dose group, Rg1 high-dose group, Epac1 agonist group, and Epac1 inhibitor group. The model group, Rg1 low, medium and high dose groups, Epac1 agonist group and Epac1 inhibitor group were all used to establish a permanent focal cerebral ischemia rat model. Rats in the Rg1 low, medium and high dose groups were treated with 60, 120 and 240 μmol/L Rg1 administered by gavage at a fixed time every morning. The rats in the Epac1 agonist and Epac1 inhibitor groups were administered intraperitoneally at a fixed time each morning with a concentration of 1.0×10

Objective:To summarize the precision fluid management of patients with severe blast injury in the emergency intensive care unit, so as to help patients smoothly pass through the dangerous period and recover smoothly.Methods:Based on the experience of fluid management in 6 patients admitted to the Second Affiliated Hospital Zhejiang University School of Medicine in the tanker truck explosion on 14 June, 2020. The main measures included: fluid volume management and dynamic adjustment; assessment of intake, output and urine volume, and dynamic adjustment of infusion volume and speed; monitoring of pulmonary oxygenation and timely adjustment of fluid resuscitation strategies; monitoring indexes and providing nursing care strategies for fluid management.Results:Finally, among 6 patients with severe blast injury, 5 patients were discharged from the hospital with follow-up treatment after they suffered from the shock and infection phases and refined fluid management, 1 patient died due to severe injury and ineffective rescue.Conclusions:Adopting individualized, phased, and refined liquid management strategy has clinical significance for patients with severe blast injury to smoothly pass the risk period.

Changes in body weight and body composition of breast cancer patients during treatment and rehabilitation have a certain relationship with their prognosis, so the weight management of patients should be paid attention by medical and nursing staff. This article reviews the changes of body weight and body composition in breast cancer patients, related factors and their impact on patients, so as to provide a reference for clinical practice and research.

Objective:To explore the application effect of physical restraint management based on quantitative assessment strategy in patients with impaired consciousness in ICU.Methods:Using the convenient sampling method, a total of 100 patients with impaired consciousness who were admitted to ICU of Zhoushan Women and Children Hospital from January 2019 to December 2021 were selected as the research objects. According to the random number table method, they were divided into the control group and the observation group, with 50 cases in each group. The patients in the control group were given routine physical restraint care, while patients in the observation group were given physical restraint management based on quantitative assessment strategies. The physical restraint time and restraint intensity of the two groups were compared. A total of 24 nurses in ICU were divided into the control group and the study group, with 12 nurses in each group. Physical restraint related knowledge and behavior survey scale were used to compare the scores between the two groups.Results:The restraint time of the observation group was shorter than that of the control group and the restraint intensity was lower than that of the control group, and the differences were statistically significant ( P<0.05) . After training, the scores of physical restraint knowledge, physical restraint attitude and physical restraint behavior of nurses in the study group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Physical restraint management based on quantitative assessment strategy can reduce the restraint intensity and restraint time of patients with impaired consciousness in the intensive care unit and improve the physical restraint knowledge and behavior scores of ICU nurses, which is worthy of clinical application.

Objective:To explore the genetic etiology for a premature ovarian insufficiency (POI) patient from a consanguineous Chinese family, and to provide basis for genetic counseling and fertility counseling.Methods:Whole-exome sequencing was performed using DNA extracted from the blood sample of POI patient. Suspected pathogenic mutation was analyzed by bioinformatics methods and verified by Sanger sequencing. The pathogenicity of the variation was assessed according to the ACMG genetic variation classification criteria and guidelines.Results:A homozygous variation, c. 32G>T (p.G11V), of PSMC3IP was identified in the patient. Bioinformatics analysis revealed that the variation was conserved in different animal species, and this variation was classified as possible pathogenic variation according to the ACMG genetic variation classification criteria and guidelines.Conclusions:The homozygous missense variation of PSMC3IP is the cause of the POI patient in this family. We are reporting for the first time the missense variation in PSMC3IP gene caused POI, which enriched the mutation spectrum of PSMC3IP and provided the basis for genetic counseling and fertility guidance of this family.

Objective:To evaluate the effect of laparoscopic hiatal hernia repair plus fundoplication on gastroesophageal reflux disease (GERD).Methods:The clinical data of 206 GERD patients with esophageal hiatal hernia treated by laparoscopic esophageal hiatal hernia repair + fundoplication at the gastroesophageal reflux center of Zhejiang People′s Hospital from Jan 2016 to Jun 2019 was retrospectively analyzed, including basic data, symptom score, auxiliary examination and follow-up.Results:All 206 patients underwent laparoscopic anti-reflux surgery successfully. There was no conversion to open surgery and no death. Preoperative Deemester scores were 46.49±37.42, while Deemester score 6 month after surgery were 6.38±4.69.Mean follow-up time was 15 months and good result were achieved in 98% of follow-up cases.Conclusion:Laparoscopic repair plus fundoplication for GERD is of minimally invasive and satisfactory, while the preoperative evaluation of surgical indications is properly conducted.