ObjectiveTo evaluate the clinical efficacy and safety of Qidan Tangshen Granules （芪丹糖肾颗粒， QTG） in the treatment of early diabetic kidney disease （DKD） with qi deficiency， blood stasis， and kidney deficiency syndrome， and to explore its mechanism. MethodsA double-blind， double-simulated method was used to enroll 200 patients with early DKD and qi deficiency， blood stasis， and kidney deficiency syndrome. Patients were randomly assigned in a 1∶1 ratio to the treatment group （100 cases） and the control group （100 cases）. The treatment group received QTG plus a valsartan capsule simulant， while the control group received valsartan capsules plus a QTG simulant， both for 12 weeks. The primary outcome was the urinary albumin-to-creatinine ratio （UACR）. Secondary outcomes included estimated glomerular filtration rate （eGFR）， fasting blood glucose （FBG）， 2-hour postprandial blood glucose （PBG）， glycated hemoglobin （HbA1c）， and traditional Chinese medicine （TCM） syndrome scores （including individual symptom scores for fatigue， dull complexion， soreness and weakness of the waist and knees， headache and chest pain， irritability， spontaneous sweating， thirst and polydipsia， polyphagia， polyuria， numbness of the limbs， and the total TCM syndrome score）. Oxidative stress markers including serum 8-hydroxy-2'-deoxyguanosine （8-OHDG）， 3-nitrotyrosine （3-NT）， and superoxide dismutase （SOD） were also assessed. Clinical efficacy and TCM syndrome efficacy were evaluated after treatment， and routine blood tests， urinalysis， and liver function tests were conducted and adverse reaction during the tria was recorded to assess safety. ResultsA total of 191 patients completed the study （95 in the treatment group and 96 in the control group）. The treatment group showed significant reductions in UACR， FBG， PBG， and HbA1c levels after treatment （P＜0.05 or P＜0.01）. The single TCM symptom scores except for polyphagia and total TCM syndrome scores significantly decreased （P＜0.05 or P＜0.01）. Compared to the control group， the treatment group had signi-ficantly lower UACR， FBG， PBG levels， and total TCM syndrome scores， sinlge symptoms scores except for polyphagia and limb numbness （P＜0.05 or P＜0.01）. Among 40 randomly selected patients （21 cases in the treatment group and 19 cases in the control group） for oxidative stress analysis， there were no significant differences in SOD， 3-NT， and 8-OHDG levels before and after treatment within or between groups （P＞0.05）. The overall effective rate in the treatment group was 64.2% （61/95） and 39.6% （38/96） in the control group， while the TCM syndrome efficacy rates were 80.0% （76/95） and 24.0% （23/96）， respectively， with the treatment group showing superior efficacy （P＜0.01）. No significant differences were observed in routine blood tests， urinalysis， or liver function indices before and after treatment in either group （P＞0.05）. The incidence of adverse reactions was 8.4% （8/95） in the treatment group and 9.4% （9/96） in the control group， with no statistically significant difference （P＞0.05）. ConclusionQTG can effectively reduce UACR and blood glucose levels， alleviate clinical symptoms， and improve clinical efficacy in patients with early DKD with qi deficiency， blood stasis， and kidney deficiency syndrome. The treatment is well-tolerated and safe， with no significant impact on oxidative stress markers.

Metformin has been demonstrated to attenuate hyperglycaemia by modulating the gut microbiota. However, the mechanisms through which the microbiome mediates metformin monotherapy failure (MMF) are unclear. Herein, in a prospective clinical cohort study of newly diagnosed type 2 diabetes mellitus (T2DM) patients treated with metformin monotherapy, metagenomic sequencing of faecal samples revealed that Phocaeicola vulgatus abundance was approximately 12 times higher in nonresponders than in responders. P. vulgatus rapidly hydrolysed taurine-conjugated bile acids, leading to ceramide accumulation and reversing the improvements in glucose intolerance conferred by metformin in high-fat diet-fed mice. Interestingly, C22:0 ceramide bound to mitochondrial fission factor to induce mitochondrial fragmentation and impair hepatic oxidative phosphorylation in P. vulgatus-colonized hyperglycaemic mice, which could be exacerbated by metformin. This work suggests that metformin may be unsuitable for P. vulgatus-rich T2DM patients and that clinicians should be aware of metformin toxicity to mitochondria. Suppressing P. vulgatus growth with cefaclor or improving mitochondrial function using adenosylcobalamin may represent simple, safe, effective therapeutic strategies for addressing MMF.

Objective To explore the effect of health education based on interactive 3D-modeling of intracranial artery on interventional diagnosis and treatment for patients with intracranial artery stenosis.Methods A total of 70 patients requiring interventional diagnosis and treatment due to intracranial artery stenosis admitted to our department in 2022 were enrolled,and randomly divided into observation group and control group,with 35 cases in each group.Their stenotic sites of intracranial arteries included the vertebral and middle cerebral arteries.The observation group received the preoperative conventional education mode combined with interactive 3D-modeling to carry out health education,while the control group got the unified education sheet and slides to carry out routine preoperative health education.A self-made publicity and education effectiveness rating scale was used to score before and after the publicity and education,and their scores of awareness of intracranial artery stenosis,awareness of treatment plans,and satisfaction with medical treatment were compared between the 2 groups.Results Before the health education,there was no statistical differences in their awareness scores concerning intracranial vessels(normal intracranial arteries,intracranial arterial occlusion,and vascular stenosis treatment)between the 2 groups patients.After the implementation of education,the awareness scores of intracranial vessels were elevated in both groups,but the awareness scores of the normal intracranial artery,intracranial artery occlusion,vascular stenosis treatment,and treatment satisfaction were significantly higher in the observation group than the control group(P＜0.05).Moreover,the patients with middle cerebral artery and vertebral artery stenosis from the observation group obtained obviously higher propaganda score than those from the control group(P＜0.05).Conclusion The health education model combined with 3D-modeling can improve the patient's awareness of the diagnosis and treatment of intracranial artery stenosis,promote their satisfaction of medical treatment,and thus increase their compliance and the rate of interventional diagnosis and treatment,and then finally,prevent strokes caused by intracranial artery stenosis.

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.

Objective Study cisplatin intraperitoneal hot perfusion chemotherapy for colorectal cancer effect a radical cure the prognosis of the patients and the influence of immune function.Methods120 patients who underwent radical resection of colorectal cancer patients, divided into observation group and control group, 60 cases in each group.The observation group were treated with cisplatin in postoperative continuous hyperthermic perfusion chemotherapy (chemotherapy for 200mg/m2 solution to cisplatin and injected with 1L), once a week, continuous treatment three weeks.The control group was treated with mFOLFOX6 intravenous chemotherapy (oxaliplatin 100mg/m2 fluorouracil leucovorin 400mg/m2, 400mg/m2), once every two weeks, 12 times of treatment.After the treatment, observation and analysis of two groups of patients before and after treatment of tumor markers (CEA, cancer antigen 19-9, cancer antigen 242), immune function (CD3+ cells, CD4+ cells, CD8+ cells, CD4+ cell ratio/CD8+ cell natural killer cells), quality of life, and the incidence of recurrence and metastasis.ResultsAfter treatment, the quality of life of patients in the observation group the total effective rate was 91.67%, significantly higher than the control group 70.00% (P<0.05), the recurrence rate is 8.33%, the metastasis rate of 10.00% was significantly higher than the control group 28.33% and 25.00% (P<0.05).The observation group of patients with carcinoembryonic antigen, cancer antigen 19-9, cancer antigen 242 level respectively (3.4±1.1)% and (17.5±7.1)% and (4.7±1.9)% was significantly lower than the control group (10.2±2.8)% and (30.1±10.3)% and (20.3±4.5)% (P<0.05), the observation of immune function effect is improved significantly better than the control group, significant differences (P<0.05).ConclusionChemotherapy after radical resection of colorectal cancer patients using cisplatin intraperitoneal hyperthermic perfusion, can significantly reduce the recurrence rate and metastasis rate, improve immune function, reduce the level of tumor markers, so as to improve the quality of life of patients.

Objective To observe the effect of Yingliu mixture combined with methimazole on autoantibodies and traditional Chinese medical syndromes of patients with Graves’ disease ( GD) . Methods A randomized, paralleled and controlled trial was carried out in 92 GD patients. The patients were evenly randomized into treatment group and control group, and were separately treated with Yingliu mixture combined with methimazole, and methimazole. The treatment for both groups lasted 12 weeks, and forty patients in each group completed the whole treatment. The changes of thyroid function, thyroid autoantibodies, and traditional Chinese medical syndrome scores were observed before and after treatment, and the clinical efficacy was also evaluated. Results (1) After treatment for 12 weeks, serum levels of thyroid peroxidase antibody (TPOAb), thyroglobulin antibody ( TGAb) and thyrotrophin receptor antibody ( TRAb) were decreased, and thyroid stimulating hormone ( TSH) was increased obviously in both groups after treatment ( P<0.01 compared with those before treatment) . The treatment group has better effect on improving TGAb and TRAb than the control group ( P<0.05). ( 2) Compared with those before treatment, the total scores of clinical symptoms and signs were decreased in the two groups at different time points of treatment course ( P<0.001) , and the decrease value in the treatment group was larger than that in the control group ( P<0.05) . ( 3) The total effective rate of the treatment group was 92.50%, higher than 82.50% of the control group ( P<0.05) . Conclusion Yingliu mixture combined with methimazole is effective on improving thyroid function, decreasing autoantibodies levels and relieving clinical symptoms and signs, and has better effect than methimazole alone for the treatment of GD.

Objective To summarize the experience in the diagnosis and treatment of hepatic trauma. Methods The clinical data of 260 patients with hepatic trauma admitted from January 1988 to December 2007 were retrospectively reviewed with regard to degree of trauma, treatment methods, therapeutical effects, complications and SO on. Results One hundred and fifty-three eases were treated by operative management,1 07 cases by nonoperative management.236 cases were cured,24 cases died,and the case fatality rate was 10.2%.There were no death among 139 patients with hepatic trauma grades Ⅰ～Ⅱ,22 death among 119 grades Ⅲ～Ⅴ patients, all death of 2 in grade VI, which demonstrated the correlation between death and hepatic trauma grade was statistically significant. Complications appeared in 82 eases, mainly including Secondary hemorrhage, abdominal infection and so on. Conclusions Nonoperative management is suitable for hepatic trauma with stable hemodynamics. Operative management is rapidly selected when the hemodynamics aren't stable. The cooperation of many specialities can enlarge the application of nonoperative management and decrease complications.

OBJECTIVE: To prepare gynecological Jiekang lotion and to establish its quality standard. METHODS: The Caffeotannic acid in Flos Lonicerae, the Berberine in Cortex Phellodendri and the Ammothamnine in Radix Sophorae Flavescentis were identified by TLC; HPLC was adopted to determine the content of Osthole with Hypersil DOS C18 as chromatograpic column. The mobile phase consisted of acetonitrile-water (54∶46) with a flow rate of 1.1mL? min-1. The detection wavelength was set at 321nm. RESULTS: Both the chief components in Jiekang lotion and the corresponding reference substances showed the identical discrimination reactions. The linear range of Osthole was 13～130?g?mL-1. CONCLUSION: The method is sensitive in qualitative reaction, specific in TLC identification, accurate in HPLC quantitation and recurrent. The established standard is applicable for the quality control of Jeikang lotion.

To explore the effects of artisense IRAK-2 oligonucleotide on the prostacyclin (PGI2) synthesis in human umbilicalvein endothelial cells (HUVEC) induced by interleukin-1 (IL-1) and tumor necrosis factor (TNF).Methods:The HUVECs were transfectedwith antisense interleulkin-1 receptor associated kinase-2 oligonucleotide (IRAK-20DN) and stimulated with IL-1 and TNF. The levels of PGI2release were analyzed by competitive ELISA. Results: Pre-transfection with antisense IRAK-20DN could remarkably decrease the levels ofPGI2 synthesis induced by IL-1 in time- and dose-dependent manner, whereas it could not attenuate the one stimulated by TNF. Conclusion:The response of antisense IRAK-2 ODN to IL-1 and TNF-stimulated PGI2 release were different. IRAK-2 plays a key role in the IL-1 signalingevents leading to PGI2 release.

Objective To study the management of vascular injury.Methods Retrospective analysis was made on the clinical data of 59 cases of vascular injury,including 55 cases of vascular injury in neck and(extremity) and 4 cases of portal vein and vena cava injury.Among them,21 cases had femoral artery injury with infection and 4 cases had vascular injury due to intervention therapy.All patients with vascular wound of extremity or neck had undergone hemostasis by compression and antishock treament before hospital admission.All cases of femoral artery injury with infection underwent hemostasis by arterial ligation and incision and(drainage) of abscess.Vascular anastomosis was performed in 11 cases,vascular grafting in 12 cases,and(vascular) repair in 14 cases.Results There were 2 deaths.5 cases had amputation(including a case of(femoral) embolism due to intervention trerapy).Postoperative intermittent claudication,decreased skin(temperature) and other signs of ischemia occurred in 21 cases of femoral artery injury with infection,but none developed limb gangrene. The other cases were discharged in good health.Conclusions In the treatment of vascular injury,wound hemostasis and antishock treatment should be done first to save the patient′s life and the management of the vascular injury depends on the situation,with the aim to try by all means to save the extremity.Vascular reconstruction is the main method for treatment of vassular injury.Vascular ligation can be done in cases of femoral artery injury with infection.