Da Qinjiaotang is the 54^th formula of the 100 formulas in the Catalogue of Ancient Classical Formulas （the first batch） ，and it originated from the Collection of Writings on the Mechanism of Disease， Suitability of Qi， and Safeguarding of Life Discussed in Plain Questions. Da Qinjiaotang is composed of Gentiana macrophylla， Glycyrrhizae Radix et Rhizoma， Ligusticum chuanxiong， Angelica sinensis， Paeonia lactiflora， Asari Radix et Rhizoma， Notopterygium incisum， Saposhnikoviae Radix， Scutellariae Radix， Gypsum， Angelica dahurica， Atractylodis Macrocephalae Rhizoma， Rehmanniae Radix， Rehmanniae Radix Praeparata， Poria， and Angelicae Pubescentis Radix. It is a classical formula for treating strokes. Da Qinjiaotang is widely used in modern clinical practices for treating ischemic stroke， peripheral facial paralysis， cervical spondylosis， rheumatic arthritis， neurodermatitis， and other multisystem diseases. Therefore， following the Principles of Textual Research on the Key Information of Ancient Classical Famous Formulas， the authors collected the ancient Chinese medical literature of Da Qinjiaotang by the method of bibliometrics and screened out 177 valid data， involving 100 ancient books of traditional Chinese medicine. Based on the historical evolution， composition， dosage， method of preparation， and preparation of the original medicinal materials of Da Qinjiaotang， a systematic study was carried out. It was found that among the 175 records of the main diseases and syndromes， stroke （144） was the most， accounting for 82.29% of the total diseases and syndromes. Later generations mostly followed the practice of LIU Wansu in using Da Qinjiaotang to treat stroke caused by "weak blood and inability to nourish tendon"， featuring "hands and feet cannot move， stiff tongue hinders speaking"， as well as other symptoms， such as slant of the mouth， hemiplegia， numbness of the limbs， paroxysmal pain， and acerbic syncope. The treatment scope was expanded， covering tendon dryness， clonic convulsion， spasm syndrome， and arthralgia syndrome. At the same time， it was found that there was a controversy between "internal wind" and "external wind" in the treatment of stroke by Da Qinjiaotang. LIU Wansu thought that stroke was caused by internal factors， created the theory of "hot stroke"， and used Da Qinjiaotang to treat "internal wind". Many doctors in later generations focused on treating the "external wind" of "internal deficiency and evil". There were 76 valid data on the composition of drugs， 59 of which had doses for each drug. It was suggested to use the modern conversion dosage of the original formula， with 41.30 g per dose. The drug should be boiled in 600 mL water until 300 mL， decocted once， and taken in a warm state after removing the dregs anytime. Through the analysis and study of the ancient books about Da Qinjiaotang， the paper clarified its historical evolution and confirmed its key information， so as to provide the ancient literature evidence for the research and development of the classical famous formula Daqinjiaotan and its better clinical application.

Da Qinjiaotang is the 54^th formula of the 100 formulas in the Catalogue of Ancient Classical Formulas （the first batch） ，and it originated from the Collection of Writings on the Mechanism of Disease， Suitability of Qi， and Safeguarding of Life Discussed in Plain Questions. Da Qinjiaotang is composed of Gentiana macrophylla， Glycyrrhizae Radix et Rhizoma， Ligusticum chuanxiong， Angelica sinensis， Paeonia lactiflora， Asari Radix et Rhizoma， Notopterygium incisum， Saposhnikoviae Radix， Scutellariae Radix， Gypsum， Angelica dahurica， Atractylodis Macrocephalae Rhizoma， Rehmanniae Radix， Rehmanniae Radix Praeparata， Poria， and Angelicae Pubescentis Radix. It is a classical formula for treating strokes. Da Qinjiaotang is widely used in modern clinical practices for treating ischemic stroke， peripheral facial paralysis， cervical spondylosis， rheumatic arthritis， neurodermatitis， and other multisystem diseases. Therefore， following the Principles of Textual Research on the Key Information of Ancient Classical Famous Formulas， the authors collected the ancient Chinese medical literature of Da Qinjiaotang by the method of bibliometrics and screened out 177 valid data， involving 100 ancient books of traditional Chinese medicine. Based on the historical evolution， composition， dosage， method of preparation， and preparation of the original medicinal materials of Da Qinjiaotang， a systematic study was carried out. It was found that among the 175 records of the main diseases and syndromes， stroke （144） was the most， accounting for 82.29% of the total diseases and syndromes. Later generations mostly followed the practice of LIU Wansu in using Da Qinjiaotang to treat stroke caused by "weak blood and inability to nourish tendon"， featuring "hands and feet cannot move， stiff tongue hinders speaking"， as well as other symptoms， such as slant of the mouth， hemiplegia， numbness of the limbs， paroxysmal pain， and acerbic syncope. The treatment scope was expanded， covering tendon dryness， clonic convulsion， spasm syndrome， and arthralgia syndrome. At the same time， it was found that there was a controversy between "internal wind" and "external wind" in the treatment of stroke by Da Qinjiaotang. LIU Wansu thought that stroke was caused by internal factors， created the theory of "hot stroke"， and used Da Qinjiaotang to treat "internal wind". Many doctors in later generations focused on treating the "external wind" of "internal deficiency and evil". There were 76 valid data on the composition of drugs， 59 of which had doses for each drug. It was suggested to use the modern conversion dosage of the original formula， with 41.30 g per dose. The drug should be boiled in 600 mL water until 300 mL， decocted once， and taken in a warm state after removing the dregs anytime. Through the analysis and study of the ancient books about Da Qinjiaotang， the paper clarified its historical evolution and confirmed its key information， so as to provide the ancient literature evidence for the research and development of the classical famous formula Daqinjiaotan and its better clinical application.

Objective To explore the risk factors of immunoglobulin resistance in children with Kawasaki disease and the effect of different treatments.Methods The clinical data of 1460 children with Kawasaki disease who were diagnosed and treated with IG in Tongji Hospital,Huazhong University of Science and Technology were included.The risk factors of IG resistance in Kawasaki disease were screened by Logistic regression analysis,and the IG resistance groups were divided into 5 groups accord-ing to different treatment regimens(group A:once IG+glucocorticoid,group B:twice IG,group C:twice IG+glucocorticoid,group D:twice IG+glucocorticoid+ulinastatin,group E:twice IG+ulinastatin),and the effects of different drug regimens in IG resistant group were analyzed.Results Multivariate Logistic regression analysis showed that the fever time was≤4 days be-fore the first dose of IG(OR 2.21,P＜0.05),monocyte count(OR1.515,P＜0.05),lymphocyte count(OR 1.117,P＜0.05),RDW-SD(OR1.083,P＜0.05),neutrophil ratio(OR 1.07,P＜0.05),erythrocyte sedimentation rate(OR 1.02,P＜0.05)and se-rum albumin concentration(OR 0.84,P＜0.05)were independent risk factors of IG resistance.There was no significant difference in the rate of coronary artery dilatation,the degree of coronary artery dilatation,and the duration of fever after the first dose of IG in IG resistant groups.Conclusion The fever time≤4 days before the first dose of IG,the increase of monocyte count,the increase of lymphocyte count,the increase of RDW-SD,the increase of neutrophil ratio,the increase of ESR,and the decrease of serum albumin concentration are the independent risk factors of IG resistance.There was no significant difference between the effect of glucocorticoid and ulinastatin on IG resistance in KD and that of IG alone.Glucocorticoid and ulinastatin combined with IG can not benefit patients.

Objective:To evaluate the feasibility and efficacy of transoral minimally invasive surgery for the treatment of lingual thyroglossal duct cyst(LTGDC) by comparison with Sistrunk surgery.Methods:The clinical data of 34 patients with LTGDC were analyzed retrospectively at the First Affiliated Hospital of Zhengzhou University from March 2019 to August 2023. Among these patients, comprising 26 males, 8 females, aged from 1 year and 11 months to 76 years old, with a mean age of 31 years old, 22 patients underwent transoral minimally invasive surgery and 12 patients underwent Sistrunk surgery. The operation time, intraoperative blood loss volume, recovery time and follow-up information of the two groups were analyzed. The follow-up period ranged from 12 to 65 months. An independent sample t-test was used to analyze the surgical duration between the two groups, while the Mann-Whitney U test was employed to analyze data on age, cyst size, intraoperative blood loss, and length of hospital stay between the two groups. Results:There were no significant differences in gender, age and size of the cysts between the two groups(all P>0.05). For the transoral minimally invasive group, the mean operation time was (75.5±20.2) minutes, median intraoperative blood loss volume was 5.0(5.0, 10.0)ml and median recovery time was 9.0(8.0, 10.0)days. The data of Sistrunk group were (131.7±16.8) min, 27.5(20.0, 40.0)ml, 11.0(10.0, 15.0)days respectively. There was a statistically significant difference between the two groups( Z=-8.192, -4.539, -3.71, all P<0.001). In the transoral group, there were three recurrences, two patients subsequently underwent Sistrunk surgery, while one opted for continuous observation. Additionally, one patient experienced partial loss of epiglottic cartilage.Four patients in the Sistrunk group developed a pharyngeal fistula, but there were no reported recurrences. Conclusions:Compared to Sistrunk surgery, transoral surgery for lingual thyroglossal duct cyst provides several benefits, such as reduced complication rates, accelerated recovery, and the absence of neck scarring.

Objective:To explore the clinical application value of magnetic resonance imaging (MRI)-guided wire localization to the non-palpable breast lesions (NPBL) identified on MRI only.Methods:A retrospective case series study was conducted. A total of 171 patients with NPBL identified on MRI only who underwent MRI-guided wire localization from April 2017 to May 2024 in Shaanxi Provincial Cancer Hospital were collected. All patients had breast MRI Breast Imaging Report and Data System (BI-RADS) 4a and above lesions, and underwent MRI-guided wire localization within the same menstrual cycle within 2 days to 2 months after diagnostic MRI examination. Based on postoperative pathological results, the MRI characteristics of benign and malignant lesions were compared, and the clinical application value of MRI-guided wire localization was evaluated.Results:There were 179 lesions in 171 patients, including 54 malignant lesions (30.17%) and 125 benign lesions (69.83%). There was no statistically significant difference in the enhancement morphology between pathological benign and malignant NPBL lesions ( χ2 = 0.04, P = 0.982), while there were statistically significant differences in breast background parenchymal enhancement, lesion time-signal intensity curve and BI-RADS classification ( χ2 values were 32.03, 20.72 and 37.60, respectively, all P < 0.05). Conclusions:For NPBL that is identified on MRI only and evaluated as BI-RDADS 4a or above, MRI-guided wire localization can improve the accuracy of diagnosis and treatment of intraductal carcinoma, early invasive cancer and high-risk lesions.

Objective To explore the transvaginal three-dimensional ultrasound characteristics in women with abnormal uterine cavity and compare the diagnostic value with hysteroscopy.Methods A total of 102 women who underwent transvaginal three-dimensional ultrasound and hysteroscopy in the Department of Ultrasound of Lu'an People's Hospital for various reasons were selected as the research subjects.Hysteroscopy was the gold standard.The three-dimensional ultrasound characteristics of patients with different uterine cavity lesions were statistically analyzed.A 2×2 4-grid table was drawn to calculate the diagnostic value of transvaginal three-dimensional ultrasound for various types of uterine cavity lesions.Results There were 22 cases of endometrial polyps,9 cases of intrauterine adhesions,and 5 cases of submucosal fibroids.The accuracy rates of diagnosing endometrial polyps,intrauterine adhesions and submucosal fibroids through transvaginal three-dimensional ultrasound were 90.91%,88.89%and 80.00%,respectively.The transvaginal three-dimensional ultrasound of patients with endometrial polyps mainly showed deformation of the uterine cavity line,high echoic masses,clear differentiation between the edge of the echogenic mass and the endometrium,almost no deformation of the endometrial basal line,and scattered distribution of blood flow on CDFI ultrasound.Intrauterine adhesions mainly manifested as uneven endometrial thickness and low echogenicity by transvaginal three-dimensional ultrasound,and fluid accumulation may found in the uterine cavity of some patients.Transvaginal three-dimensional ultrasound showed that submucosal fibroids were mainly hypoechoic,elliptical or irregular in shape,with CDFI revealing abundant blood flow signals.Conclusion When women with abnormal uterine cavity are examined with transvaginal three-dimensional ultrasound,patients with different types of lesions have different typical ultrasound characteristics,and transvaginal three-dimensional ultrasound diagnosis has a high diagnostic accuracy with respect to hysteroscopy as the gold standard,exhibiting its advantages of non-invasive and rapid diagnosis,worthy of clinical promotion.

Objective To investigate the potential beneficial predictors for endovascular treatment(EVT)in case of acute anterior circulation large vessel occlusion with large-core infarction.Methods We made a retrospective inclusion of 92 patients with anterior circulation large vessel occlusion and core infarct volume ranging from 50 to 100 mL,who underwent EVT at Zhangzhou Municipal Hospital of Fujian Province from March 2018 to February 2021.All the patients were confirmed as anterior circulation large infarction and large infarct volume using computed tomography(CT),computed tomography angiography(CTA),and computed tomography perfusion(CTP)before EVT.All clinical and imaging data were collected to observe the postoperative recurrence rate,incidence of symptomatic intracranial hemorrhage(sICH),and functional prognosis 90 days.Then the patients were divided into favorable outcomes group(mRS≤3)and unfavorable outcomes group(mRS＞3)based on Rankin scores 90 days post-stroke.Univariate and multivariate Logistic analysis were conducted to analyze factors influencing the patients'prognosis.By combining the results of multivariate analysis,we constructed receiver operating characteristic(ROC)curves and identified the cut-off value to evaluate the predictive value of age for post-vascular treatment prognosis.Results Among the included patients,the postoperative revascularization rate(mTIICI≥2b)was 95％(88 cases),the rate of favorable outcomes at 90 days postoperatively(mRS≤3)was 32.61％(30 cases),the incidence of sICH was 13％,and the mortality rate was 31.5％.Compared with the unfavorable outcomes group,the favorable outcomes group had a younger age and a higher proportion of males.Multivariate analysis indicated that older age was an independent risk factor for adverse outcomes following endovascular treatment(OR=4.97,95％CI:1.78-13.90,P=0.002).The ROC curve indicated that the area under the curve was maximized at the age of 72.5 years(AUC=0.763,95％CI:0.661-0.864,P＜0.001).Its sensitivity and specificity was 0.565 and 0.833,respectively.Conclusion Age is an independent predictor of the prognosis of acute procirculatory large core stroke.Patients with large core infarction older than 72.5 years may not benefit from endovascular therapy,which needs to be confirmed by a multicenter large sample prospective randomized controlled trial.

A 66-year-old male patient received abrocitinib 100 mg once daily orally for atopic dermatitis. After 3 and a half months, the patient′s condition was significantly improved and the dose of abrocitinib was reduced to 100 mg once every 2 days orally. After 35 days of continuous medication, the patient developed a sense of stuffiness in both ears, occasional tinnitus, and hearing loss. According to specialized examinations in otolaryngology, the sudden deafness was diagnosed, which was considered to be related to abrocitinib. Abrocitinib was stopped. After 38 days of treatments with nurturing nerves, improving circulation, his hearing basically returned to normal. After that, dermatitis recurred in the patient, and he received abrocitinib 100 mg once daily orally again. One month later, the patient developed hearing loss again. After 9 days of drug withdrawal, the patient′s tinnitus and other symptoms were basically relieved. Subsequently, abrocitinib was placed by dupilumab to treat atopic dermatitis in the patient. At a six-month of follow-up, symptoms such as tinnitus and hearing loss did not recur.

Objective:To explore the efficacy of linaclotide combined with compound polyethylene glycol (PEG) on bowel preparation, and compare it with traditional PEG 3 L and oral sulfate solution (OSS) 3 L methods.Methods:Patients aged 18-70 years who underwent colonoscopy at the Digestive Diseases Hospital, Heilongjiang Provincial Hospital from January to June 2023 were continuously enrolled in the randomized controlled trial and randomly divided into 3 groups using the random number table. Intestinal preparation was conducted according to the protocols of each group, Group A: 3 L PEG; Group B: 3 L OSS; Group C: 290 μg of linaclotide + 2 L PEG. The effects of bowel preparation, adverse reactions, satisfaction, and willingness for repeated bowel preparation were compared.Results:A total of 360 patients were included in the analysis, with 120 patients in each group. There were no statistically significant differences in the median Boston bowel preparation score for each intestinal segment or the total score among the 3 groups (left colon: 3 VS 2 VS 3, H=0.371, P=0.831; transverse colon: 3 VS 3 VS 3, H=0.487, P=0.784; right colon: 2 VS 2 VS 2, H=1.088, P=0.580; total score: 8 VS 8 VS 8, H=0.017, P=0.991). Among the adverse reactions, the incidence of nausea and vomiting in Group B [3.33% (4/120)] was lower than that in Group A [12.50% (15/120), χ2=8.042, P=0.018], and there were no statistically significant differences in other adverse reactions among the 3 groups ( P>0.05). There was no significant difference in the satisfaction level among the 3 groups ( χ2=11.840, P=0.158). The willingness to undergo bowel preparation again in Group C [95.83% (115/120)] and Group B [96.67% (116/120)] was higher than that in Group A [85.00% (102/120)] (Group C VS Group A: χ2=8.127, P=0.004; Group B VS Group A: χ2=9.808, P=0.002), and there was no significant difference between Group C and B ( χ2=0.000, P=1.000). Conclusion:Linaclotide combined with 2 L PEG offers comparable bowel preparation efficacy and safety to 3 L PEG or 3 L OSS, with improved patient compliance due to reduced water intake, suggesting its potential as an enhanced bowel preparation regimen.

Objective To investigate the mechanism by which miR-148a affects M2 macrophage polarization and inhibits liver cancer cell proliferation through Wnt3a/β-catenin. Methods The mRNA expression levels of miR-148a, CD206 and interleukin-10 (IL-10) in tumor tissues and adjacent non-tumor liver tissues of 84 patients with liver cancer were detected by real-time quantitative PCR. THP-1 cells were separated into blank group (conventional culture), M2 group (200 nmol/L phorbol ester, 20 ng/mL IL-4, 20 ng/mL IL-13), M2 combined with negative control (miR-NC) group (transfected with miR-NC on the basis of M2 group), M2 combined with miR-148a mimics (transfected with miR-148a mimics on the basis of M2 group) group, M2 combined with miR-148a mimics combined with Wnt3a (treated with 100 μg/L Wnt3a on top of M2 combined with miR-148a mimics group) group. The proliferation of HuH7 cells was detected by CCK-8 and EdU methods. Apoptosis and M2 macrophage marker CD206 was detected by flow cytometry. The level of IL-10 in cell supernatant was detected by chemiluminescence method; The mRNA levels of miR-148a, CD206 and IL-10 were detected by real-time quantitative PCR. The protein levels of Wnt3a and β-catenin were detected by Western blot. Results The expressions of CD206, IL-10 mRNA, Wnt3a and β-catenin in tumor tissue were higher than those in non-tumor liver tissues, and the miR-148a level was decreased. The mRNA expression of M2 macrophage markers CD206 and IL-10 were significantly increased. Compared with the blank group, the OD450 value, EdU positive rate, the mRNA expressions of CD206 and IL-10, the level of IL-10 in the supernatant, and the expressions of Wnt3a and β-catenin were increased in M2 group, while the apoptotic rate and miR-148a level were decreased. Compared with M2 group and M2 combined with miR-NC group, the OD₄₅₀ value, EdU positive rate, the mRNA expressions of CD206 and IL-10, the level of IL-10 in the supernatant, and the expressions of Wnt3a and β-catenin were decreased in M2 combined with miR-148a mimics group, while the apoptotic rate and miR-148a level were increased. Wnt3a reversed the inhibitory effect of miR-148a overexpression on the proliferation of liver cancer cells. Conclusion Overexpression of miR-148a inhibits M2 polarization of macrophages and prevents the proliferation of liver cancer cells, which may be related to the inhibition of the Wnt3a/β-catenin pathway.
Humans ; MicroRNAs/metabolism* ; Wnt3A Protein/metabolism* ; Liver Neoplasms/metabolism* ; Cell Proliferation/genetics* ; beta Catenin/genetics* ; Macrophages/metabolism* ; Interleukin-10/metabolism* ; Apoptosis/genetics* ; Cell Line, Tumor ; Female ; Male ; Mannose Receptor ; Lectins, C-Type/metabolism* ; Mannose-Binding Lectins/metabolism* ; Middle Aged ; Receptors, Cell Surface/metabolism*