BACKGROUND:Previous studies by our research group discovered that Jiawei Xiaoyao San has a significant anti-liver cancer effect,but the specific mechanism of action was unclear. OBJECTIVE:To investigate the regulatory effects of the traditional Chinese medicine formula Jiawei Xiaoyao San on the levels of miRNAs in plasma exosomes of rats with diethylnitrosamine chronically induced primary liver cancer,based on high-throughput sequencing combined with bioinformatics. METHODS:SD rats were randomly divided into a blank control group,a liver cancer model group,and a Jiawei Xiaoyao San treatment group.Liver cancer models were induced by continuous administration of diethylnitrosamine for 12 weeks.Starting from the 17th week,rats in the Jiawei Xiaoyao San treatment group were administered Jiawei Xiaoyao San once daily until the end of the 20th week,while rats in the blank control and liver cancer model groups were given an equivalent volume of saline.Anti-hepatocellular carcinoma effects were validated by assessing the morphological structure of rat liver tissues,along with the expression of the hepatocellular carcinoma markers,Glypican-3 protein and serum alpha-fetoprotein.Plasma exosomes from each group of rats were isolated using ultracentrifugation.High-throughput sequencing technology was used to screen for differentially expressed miRNAs in rat plasma exosomes.Bioinformatics was used to predict the potential biomarkers through which Jiawei Xiaoyao San exerts its anti-liver cancer effects via liver cancer-derived exosomal miRNAs,followed by functional analysis. RESULTS AND CONCLUSION:(1)Jiawei Xiaoyao San significantly improved the morphological structure of liver tissues in a rat model of liver cancer.Compared with the liver cancer model group,the expression of liver cancer markers Glypican-3 protein and serum alpha-fetoprotein was significantly reduced in the Jiawei Xiaoyao San treatment group.(2)Bioinformatics analysis showed that in the Jiawei Xiaoyao San group,upregulated miR-223-3p in the liver cancer model group had target binding sites with genes E2F1 and NCOA1,which were closely related to liver cancer survival and prognosis.Therefore,Jiawei Xiaoyao San has a therapeutic effect on liver cancer,possibly by targeting negative regulation of NCOA1/E2F1 through liver cancer plasma-derived exosomal miR-223-3p,thereby playing anti-liver cancer effect.

Objective:To summarize the clinical characteristics and management experience of complications in patients with cervical necrotizing fasciitis （CNF） with or without descending necrotizing mediastinitis （DNM）, in order to provide a basis for optimizing diagnosis and treatment strategies. Methods:A retrospective analysis was conducted on the clinical data of 31 patients diagnosed with CNF and DNM at Shandong Provincial Hospital Affiliated to Shandong First Medical University between October 2019 and March 2024. A comprehensive evaluation was performed based on the patients' clinical characteristics, metagenomic next-generation sequencing （mNGS） pathogen detection results, imaging assessments, surgical interventions, management approaches for specific complications, and prognostic outcomes. Results:Among the 31 patients, 10 had severe diabetes mellitus. Etiological analysis was summarized as follows: 5 cases were odontogenic, 3 were of tonsillar origin, 3 were due to endogenous esophageal injury, 2 were due to exogenous cervical trauma, 2 originated from a congenital branchial cleft fistula, and 16 cases had an unknown etiology. Among them, 29 patients underwent surgery via an external cervical approach, 1 patient underwent surgery via an intraoral approach, and 1 patient received ultrasound-guided puncture and drainage therapy. Ultimately, 29 patients were cured and discharged （including 1 patient who experienced two instances of major neck vessel rupture and successfully underwent two interventional embolization procedures for hemostasis）; 2 patients died after failed rescue efforts due to concurrent sepsis and multiple organ dysfunction. The treatment success rate was 93%, and the mortality rate was 7%. In this cohort of CNF and DNM cases, only a minority had a clearly identified odontogenic cause; although the etiology was unknown in most cases, imaging consistently showed oropharyngeal lymph node necrosis, suggesting a possible pharyngeal origin of infection in adults. The mNGS pathogen profile was predominantly Gram-positive bacteria, accompanied by anaerobic bacilli and fungi. Conclusion:CNF and DNM are severe and rapidly progressive conditions that can lead to life-threatening complications within hours. Timely recognition can reduce unnecessary examinations and expedite treatment.
Humans ; Retrospective Studies ; Fasciitis, Necrotizing/therapy* ; Mediastinitis/complications* ; Neck/pathology* ; Male ; Female ; Middle Aged ; Adult ; Aged ; Prognosis

Objective:To investigate the effects of Zhuanggu Zhitong Capsules on JNK signaling molecules and their phosphorylated proteins in postmenopausal osteoporosis model female mice.Methods:The rats were divided into sham-operation group, blank group, model group, positive drug group, and Zhuanggu Zhitong Capsules group according to the random number table method, with 10 rats in each group. The model group, the positive drug group and the Zhuanggu Zhitong Capsules group were prepared by bilateral ovarian detomy to prepare a female mouse model of postmenopausal osteoporosis. The positive drug group was given 0.9 mg/kg of alendronate sodium, the Zhuanggu Zhitong Capsules group was given was Zhuanggu Zhitong Capsules 1.944 g/kg for gavage, and the blank group, sham-operation group, and model group were given the same volume of normal saline for gavage, once a day for a total of 13 weeks. Rat vaginal exfoliated cells were stained with Wright's staining; serum Omentin-1 and 25(OH)D 3 levels were determined by ELISA; renal tissue and femoral structure were observed by HE staining; JNK and p-JNK protein expressions were detected by immunohistochemical staining; JNK mRNA levels were detected by PCR. Results:Compared with the model group, the serum levels of 25(OH)D3 and Omentin-1 in the Zhuanggu Zhitong Capsules group and the positive drug group increased ( P<0.01), the mean gray values of JNK and p-JNK protein in bone and kidney tissues decreased ( P<0.01), and the mRNA levels of JNK in bone and kidney tissues decreased ( P<0.01). Conclusion:Zhuanggu Zhitong Capsules can effectively improve the bone microstructure of postmenopausal osteoporotic rats, and its mechanism may be related to the regulation of JNK signaling pathway.

Objective To investigate the expression of serum tumor-associated antigens(TAAs)in patients with rheumatoid arthritis(RA)and analyze their clinical significance for RA.Methods A total of 214 RA patients were enrolled in the RA group,while 198 age-and gender-matched healthy individuals were included in the HC group.Rheumatoid factor(RF),anti-cyclic citrullinated peptide antibody(Anti-CCP),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleu-kin-6(IL-6),ferritin levels,as well as gender,age,disease duration,disease activity score(DAS28)and clinical manifestations were collected from the RA group.The expression of TAAs in RA patients and the clinical characteristics of TAA-positive patients were analyzed.Spearman correla-tion analysis was used to evaluate the relationships between TAAs and clinical indicators in RA pa-tients.Results The positive rate of carbohydrate antigen 125(CA125)in the RA group was 8.88％,which was significantly higher than 1.01％ in the HC group(P＜0.001).Serum CA125 and cytok-eratin fragment 19(CYFRA21-1)levels in the RA group were significantly higher than those in the HC group,whereas alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA),carbohydrate anti-gen 199(CA199)and neuron-specific enolase(NSE)levels were significantly lower(P＜0.001).TAA-positive patients had significantly older age and higher rates of pulmonary interstitial lesions compared to TAA-negative patients(P＜0.05).Patients with DAS28 scores＞5.1 had significantly higher CA125 levels than those with DAS28 scores ≤5.1(P＜0.05).CA125 levelswere positively corre-lated with DAS28 scores,ESR,RF,and anti-CCP antibodies(r=0.142,0.140,0.268,0.183;P＜0.05).Conclusion In RA patients,the positivity rate and levels of some serum TAAs are ele-vated,and TAA-positive patients tend to be older and have higher incidence of pulmonary interstitial lesions.CA125 levels are positively correlated with RA disease activity.

Objective To observe and compare the effect of remimazolam combined with nalbuphine and midazolam combined with nalbuphine on postoperative recovery in elderly patients undergoing fibrobronchoscopy.Methods A total of 112 elderly patients undergoing fibrobronchoscopy,56 males and 56 females,aged ≥ 65 years,BMI 18.5-28.0 kg/m2,ASA physical status I or Ⅱ,were ran-domly divided into two groups:midazolam group and remimazolam group,56 patients in each group.The midazolam group received midazolam 0.03 mg/kg combined with nalbuphine 0.1 mg/kg for anesthesia.The remimazolam group received remimazolam 0.1 mg/kg combined with nalbuphine 0.1 mg/kg for anesthesia.HR,MAP,SpO2,and RR were recorded after entering room,before anesthesia induction,5 minutes after anesthesia induction,and at the end of the operation.The onset time of anesthesia,the time of awakening,the time of operation,the time of discharge,the number of successful cases of sedation,the number of suc-cessful cases of endoscopy,and the occurrence of adverse events were recorded.The satisfaction of the pa-tient,anesthesiologist,and endoscopist were also recorded.Results Compared with the midazolam group,HR and MAP were significantly increased 5 minutes after induction and the end of operation in the remima-zolam group(P＜0.05),the onset time of anesthesia and the time of awakening were significantly short-ened(P＜0.05),the incidence of hypotension,respiratory depression and nausea and vomiting were sig-nificantly reduced(P＜0.05),and the rae of very satisfaction of the operating physician was significantly increased(P＜0.05).There were no significant differences in the time of separation,the success rate of sedation and the success rate of endoscopy between the two groups.Conclusion Compared with midazolam,remimazolam combined with nalbuphine can be safely used for flexible bronchoscopy in elderly patients,reduce recovery time and adverse reactions,which is conducive to rapid postoperative recovery.

In November 2023, the seventh National Nucleic Acid Vaccine Conference was held to deeply discuss the immune mechanism, safety risks, advantages, and disadvantages of nucleic acid vaccines, and review the safety and effectiveness of COVID-19 vaccines developed by nucleic acid vaccine technology. Some prospectives were formed in the meeting that in the post-pandemic era, nucleic acid vaccine technology will play a role in the following areas: dealing with pathogens that are difficult to be prevented by traditional vaccines, promoting the upgrading of traditional live attenuated vaccines, contributing to the development of multivalent and combined vaccines, and rapid response to emerging and re-emerging infectious diseases. These views point out the direction for the future development of nucleic acid vaccine technology.

Objective:To analyze the significance and factors influencing of CT scan under the modified Valsalva maneuver. Methods:Clinical data of 52 patients with hypopharyngeal carcinoma diagnosed from August 2021 to December 2022 were collected, all patients had calm breathing CT scan and modified Valsalva maneuver CT scan. Compare the exposure effect of the aryepiglottic fold, interarytenoid fold, postcricoid area, piriform fossa apex, posterior hypopharyngeal wall, and glottis with each CT scanning method. The effects of age, neck circumference, neck length, BMI, tumor site, and T stage on the exposure effect were analyzed. Results:In 52 patients, 50 patients（96.15%） completed CT scan at once time. The exposure effect of the CT scan under modified Valsalva maneuver in the aryepiglottic fold, interarytenoid fold, postcricoid area, piriform fossa apex, posterior hypopharyngeal wall was significantly better than CT scan under calm breathing（Z=-4.002, -8.026, -8.349, -7.781, -8.608, all P<0.01）, while CT scan under modified Valsalva maneuver was significantly worse in glottis than CT scan under calm breathing（Z=-3.625, P<0.01）. In the modified Valsalva CT scan, age had no obvious effect on the exposure effect. The exposure effect was better with long neck length, smaller neck circumference, smaller BMI and smaller T stage. The exposure of postcricoid carcinoma was better than pyriform sinus carcinoma and posterior hypopharyngeal wall carcinoma. But differences were not all statistically significant. Conclusion:The anatomical structure of the hypopharynx was clearly under CT scan with modified Valsalva maneuver, which clinical application is simple, but the effect of glottis was worse. The influence of age, neck circumference, neck length, BMI, and tumor T stage on the exposure effect still needs further investigation.
Humans ; Hypopharynx/diagnostic imaging* ; Valsalva Maneuver ; Hypopharyngeal Neoplasms/surgery* ; Tomography, X-Ray Computed ; Carcinoma

Objective To summarize the experience of minimally invasive tracheotomy under veno-venous extracorporeal membrane oxygenation(VV-ECMO)in 4 cases of severe pneumonia,and to provide examples for airway management of severe pneumonia patients.Methods A retrospective study method was conducted.Four cases of severe pneumonia patients who underwent extracorporeal membrane oxygenation(ECMO)at the intensive care unit(ICU)of Shandong Provincial Hospital Affiliated to Shandong First Medical University from November 2022 to March 2023 were selected as the study subjects,clinical data on the general conditions,imaging examinations before and after admission to ICU,changes in biochemical indexes before and after ECMO technique,and the performance of bedside minimally invasive tracheotomy were collected.Bedside tracheotomy was performed to assist ventilation for patients according to the change of condition.The changes and prognosis of the patients were observed.Results Four patients with severe pneumonia were treated with bedside tracheotomy-assisted ventilation in the state of continuous VV-ECMO,the oxygen saturation was maintained between 0.98-1.00,the airway was cleared and sputum evacuation was smooth,the vital signs were stable after the operation,and the machine was gradually withdrawn.Conclusion During the treatment of severe pneumonia,the safe and rapid completion of bedside minimally invasive tracheotomy in patients with severe pneumonia under continuous VV-ECMO is a new challenge shared by doctors and nurses of otorhinolaryngology,head and neck surgery,and critical care emergency care unit.The four successful cases of bedside tracheotomy after VV-ECMO treatment we report suggest that bedside minimally invasive tracheotomy can safely and rapidly assist airway management,and may provide more useful experiences for the treatment of severe pneumonia and possible new acute respiratory infectious diseases in the future.

Objective To provide guidance for pre-hospital emergency treatment by studying the disease spectrum and distribution characteristics of pre-hospital emergency treatment patients in Wuxi area from 2015 to 2020. Methods The medical records of 120 pre-hospital emergency patients in Wuxi area from January 2015 to December 2020 were retrospectively analyzed, and the disease types, gender, age, and seasonal distribution of the pre-hospital emergency patients were statistically analyzed. Results The top five emergency diseases of 16 437 pre-hospital patients were trauma (24.51%), cerebrovascular disease (19.16%), cardiovascular disease (18.33%), digestive system disease (9.70%) and respiratory disease (7.20%). In the distribution of disease types, the proportions of injuries, cerebrovascular diseases, cardiovascular diseases, digestive system diseases, respiratory system diseases, poisoning diseases and urinary system diseases in males were significantly higher than those in females (χ²=4.975, P<0.05). The proportion of male species (9 812/16 437) was higher than that of female species (6 625/16 437). From 2015 to 2020, the age group with high incidence of pre-hospital emergency patients in Wuxi area was distributed in the 50-60 years old (19.30%) and 40-50 years old (16.28%), and the least age group was 0-10 years old (2.60%). The number of pre-hospital emergency patients was 46.60% from 6 to 12 hours per day, and 10.26% from 18 to 24 hours per day. The number of pre-hospital emergency patients was the highest in summer (38.69%), and the lowest in spring (11.87%). Conclusion The pre-hospital emergency diseases in Wuxi area are mainly cardiovascular and cerebrovascular diseases, and the acute and severe diseases show an increasing trend. It is necessary to rationally allocate the pre-hospital emergency resources according to the disease spectrum and the peak months and time periods of different diseases, so as to improve the medical service level in Wuxi.

Objective:To evaluate the effectiveness of staged modular theory and practice lectures in laparoscopic training.Methods:In this study, a large group of medical students and a large group of residents were selected, and each of the two groups was divided into an experimental group and a control group respectively. The experimental group received staged modular theory and practice lectures based on the conventional trainings, and the control group only underwent conventional laparoscopic skills training and instruction. Before and after the training, the completion time of 6 basic laparoscopic operations, laparoscopic suture time, suture quality and the number of accidental injuries were recorded and scored in each group according to the assessment criteria. SPSS 26.0 was used for statistical analysis of the assessment data. Independent samples t-test or Mann-Whitney U test was used for inter-group comparison between the two large groups, and paired samples t-test or Wilcoxon sign rank sum test was used for intra-group comparison before and after the training. Results:Compared with the control group, the experimental group of medical students that had undergone staged modular theory and practice lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=6.18, P<0.001) and higher quality of suturing ( t=4.17, P<0.001) and fewer accidental injuries ( Z=-2.03, P=0.043); the experimental group of residents that had undergone staged modular theoretical and practical lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=3.31, P=0.002) and higher quality of suturing ( t=3.68, P=0.001) and fewer accidental injuries ( Z=-2.44, P=0.015). Conclusion:The staged modular theory and practice lectures are able to further improve the quality of basic laparoscopic skills training.