Functional dyspepsia （FD） is a prioritized disease category where traditional Chinese medicine （TCM） demonstrates distinct therapeutic advantages. The current western medicine treatment for FD is mainly based on proton pump inhibitors and prokinetic agents， with digestive enzymes， probiotics and antidepressants serving as adjuvant medication， yet such therapies still have certain limitations. TCM treatment for FD includes oral administration of Chinese herbal formulas and Chinese patent medicines， as well as external TCM therapies such as acupuncture and moxibustion， acupoint application， hot medicinal compress therapy， rubbing with ointment， medicinal iontophoresis， auricular acupoint therapy and tui na （Chinese medical massage）. The combined treatment of FD with integrated TCM and western medicine can significantly improve clinical effectiveness and reduce adverse reactions. The common mechanisms underlying the therapeutic effects of both TCM and western medicine revolve around the core pathological processes of FD， mainly focusing on restoring gastrointestinal motility， regulating the levels of brain-gut peptides， modulating intestinal microecology， and ameliorating inflammatory status. The differential mechanisms lie in the precise targeting feature of western medicine versus the holistic-regulating and multi-target characteristics of TCM， and the two approaches exert a synergistic effect to enhance efficacy. This paper proposes to leverage the advantages of TCM in holistic regulation and the strengths of western medicine in targeted treatment， so as to provide personalized and comprehensive treatment regimens for FD patients.

Objective To explore the mechanism of Banxia Tiaozhong Granules in the treatment of reflux esophagitis(RE).Methods A rat model of RE was established using anterior gastric ligation combined with external partial pyloric ligation.The rats were randomly divided into sham-operation group,model group,positive control group,and Banxia Tiaozhong Granules low-,medium-and high-dosage groups.After 7 days of modeling,each group was given corresponding intervention for 14 consecutive days.HE staining was used to observe the morphology of esophageal tissue,immunofluorescence staining was used to observe the expression of interstitial cells of Cajal(ICC)in esophageal tissue,RT-qPCR was used to detect the expressions of stem cell factor(SCF)and c-kit mRNA in esophageal tissue,Western blot was used to detect the expressions of SCF and c-kit protein in esophageal tissue,ELISA was used to detect the contents of serum motilin(MTL),gastrin(GAS)and vasoactive intestinal peptide(VIP).Results Compared with the sham-operation group,the interstitial space of esophageal squamous epithelial cells widened in the model group rats,basal cells proliferated,and a large number of inflammatory cells infiltrated the mucosal layer,the number of ICC in esophageal tissue significantly decreased(P<0.01),while the expression of SCF,c-kit mRNA and protein significantly increased(P<0.01);the contents of serum MTL and GAS were significantly reduced(P<0.01),the content of VIP significantly increased(P<0.01).Compared with the model group,the proliferation of basal cells and infiltration of inflammatory cells in esophageal tissue were reduced to varying degrees in the positive control group and each dosage group of Banxia Tiaozhong Granules,the number of ICC significantly increased in the positive control group and Banxia Tiaozhong Granules medium-and high-dosage groups(P<0.01),the expressions of SCF and c-kit mRNA and protein were significantly decreased(P<0.01);the serum MLT and GAS contents significantly increased(P<0.01),while VIP content significantly decreased(P<0.01).Conclusion Banxia Tiaozhong Granules can regulate gastrointestinal hormones,activate the SCF/c-kit signaling pathway,maintain ICC function,thereby regulating esophageal motility,improving esophageal mucosal inflammation,and playing a therapeutic role in RE.

Objective To explore the mechanism of Banxia Tiaozhong Granules in the treatment of reflux esophagitis(RE).Methods A rat model of RE was established using anterior gastric ligation combined with external partial pyloric ligation.The rats were randomly divided into sham-operation group,model group,positive control group,and Banxia Tiaozhong Granules low-,medium-and high-dosage groups.After 7 days of modeling,each group was given corresponding intervention for 14 consecutive days.HE staining was used to observe the morphology of esophageal tissue,immunofluorescence staining was used to observe the expression of interstitial cells of Cajal(ICC)in esophageal tissue,RT-qPCR was used to detect the expressions of stem cell factor(SCF)and c-kit mRNA in esophageal tissue,Western blot was used to detect the expressions of SCF and c-kit protein in esophageal tissue,ELISA was used to detect the contents of serum motilin(MTL),gastrin(GAS)and vasoactive intestinal peptide(VIP).Results Compared with the sham-operation group,the interstitial space of esophageal squamous epithelial cells widened in the model group rats,basal cells proliferated,and a large number of inflammatory cells infiltrated the mucosal layer,the number of ICC in esophageal tissue significantly decreased(P<0.01),while the expression of SCF,c-kit mRNA and protein significantly increased(P<0.01);the contents of serum MTL and GAS were significantly reduced(P<0.01),the content of VIP significantly increased(P<0.01).Compared with the model group,the proliferation of basal cells and infiltration of inflammatory cells in esophageal tissue were reduced to varying degrees in the positive control group and each dosage group of Banxia Tiaozhong Granules,the number of ICC significantly increased in the positive control group and Banxia Tiaozhong Granules medium-and high-dosage groups(P<0.01),the expressions of SCF and c-kit mRNA and protein were significantly decreased(P<0.01);the serum MLT and GAS contents significantly increased(P<0.01),while VIP content significantly decreased(P<0.01).Conclusion Banxia Tiaozhong Granules can regulate gastrointestinal hormones,activate the SCF/c-kit signaling pathway,maintain ICC function,thereby regulating esophageal motility,improving esophageal mucosal inflammation,and playing a therapeutic role in RE.

Objective:To investigate impacts of usnic acid(UA)on malignant behavior of gastric cancer cells by regulating the chemokine(C-C motif)ligand 2(CCL2)-CCL2 receptor(CCR2)signal axis.Methods:SGC-7901 cells,a well growing human gastric cancer cell line,were treated with different concentrations of UA,which were grouped into low concentration(UA-L)group(62.5 μmol/L UA),medium concentration(UA-M)group(125 μmol/L UA)and high concentration(UA-H)group(250 μmol/L UA);meantime,the cells were transfected with CCL2 overexpression vector(pc DNA3.1 CCL2),empty vector(pc DNA3.1),silenced CCL2(si CCL2)and negative control(si control),and SGC-7901 cells were treated with 250 μmol/L UA,labeled as UA-H+pc DNA3.1 CCL2 group,UA-H+pc DNA3.1 group,UA-H+si control group and UA-H+si CCL2 group,another untreated SGC-7901 cells were taken as the control group.Flow cytometry,MTT and qRT-PCR were applied to detect cell apoptosis,proliferation,and expres-sion levels of CCL2 and CCR2 mRNA;Western blot was applied to detect expression levels of PD-L1,apoptotic protein(Bax),proli-ferative protein(CyclinD1,CCL2,CCR2)and immune escape related protein(B7H1);after co-culturing with CD8+T cells isolated and cultured in vitro,ELISA was applied to detect levels of IL-4,IFN-γ and IL-10 in the supernatant.Gastric cancer cells in each group were co-cultured with activated peripheral blood mononuclear cell(PBMC)1∶1 for 72 hours,and the sensitivity of gastric can-cer cells in each group to T-cell-mediated killing was compared.Results:Compared with control group,cell proliferation rate,IL-10 level,CyclinD1,PD-L1,CCL2,CCR2 and B7H1 protein and mRNA expressions,cell counts after co-culturing with activated PBMC 1∶1 for 72 hours in UA-L group,UA-M group and UA-H group were obviously reduced,while apoptosis rate,IL-4 and IFN-γ levels,Bax protein expression were obviously increased(P<0.05);compared with UA-H+pc DNA3.1 group,cell proliferation rate,IL-10 level,CyclinD1,PD-L1,CCL2,CCR2 protein and mRNA expressions,cell counts after co-culturing with activated PBMC 1∶1 for 72 hours in UA-H+pc DNA3.1 CCL2 group were obviously increased,while apoptosis rate,IL-4 and IFN-γ levels,and Bax protein ex-pression were obviously reduced(P<0.05);compared with UA-H+si control group,cell proliferation rate,IL-10 level,CyclinD1,PD-L1,CCL2,CCR2 and B7H1 protein and mRNA expressions,cell counts after co-culturing with activated PBMC 1∶1 for 72 hours in UA-H+si CCL2 group were obviously reduced,while apoptosis rate,IL-4 and IFN-γ levels and Bax protein expression were obviously increased(P<0.05).Conclusion:UA can inhibit gastric cancer cells proliferation,immune escape,and induce apoptosis,which may be related to the inhibition of the CCL2-CCR2 signaling axis.

ObjectiveTo explore the application effect of Jianpi Huoxue prescription combined with acupuncture in patients with chronic atrophic gastritis （CAG） of gastric blood stasis type. MethodA total of 86 patients with CAG admitted to Wuhan First Hospital from November 2021 to March 2023 were selected and randomly divided into two groups. The control group was treated with conventional Western medicine， while the observation group was treated with Jianpi Huoxue prescription combined with acupuncture. The clinical efficacy， traditional Chinese medicine （TCM） syndrome score， pathological score， negative conversion rate of Helicobacter pylori （Hp）， inflammatory indicators ［neutrophils/lymphocytes （NLR） and interleukin （IL）-1β］， changes in levels of gastric protease （PG） Ⅰ， PG Ⅰ/PG Ⅱ， and gastrin-17 （G-17）， and drug safety during treatment were observed after treatment in both groups. ResultAfter treatment， the total effective rate of the observation group ［95.35% （41/43）］ was significantly better than that of the control group ［79.07% （34/43）］， and the difference was statistically significant （χ²=5.108， P<0.05）. After treatment， the scores of the primary and secondary TCM syndromes in the observation group and the control group were significantly decreased （P<0.05）. After treatment， the scores of primary and secondary TCM syndromes in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the pathological scores of gastric mucosa atrophy， activity， chronic inflammation， intestinal metaplasia， and dysplasia were significantly lower in the observation group and control group （P<0.05）. After treatment， the pathological scores of gastric mucosa atrophy， activity， chronic inflammation， intestinal metaplasia， and dysplasia in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the Hp conversion rate in the observation group was significantly increased compared with the control group （P<0.05）. After treatment， the levels of inflammatory indicators NLR and IL-1β in the observation group and control group were significantly lower （P<0.05）， and the levels of inflammatory indicators NLR and IL-1β in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the levels of PGI and PGⅠ/PGⅡ in the observation group and control group were significantly higher （P<0.05）， and the levels of PGI and PGⅠ/PGⅡ in the observation group were significantly higher than those in the control group （P<0.05）. After treatment， the G-17 level of the observation group and the control group was different at different time points （P<0.05）， and the G-17 level of the observation group was higher at different time points than that of the control group （P<0.05）. The G-17 level of the observation group had an increasing trend compared with the control group （P<0.05）. There was no significant difference in the risk of adverse reactions between the two groups. ConclusionThe combination of Jianpi Huoxue prescription and acupuncture can effectively alleviate symptoms， increase Hp negative conversion rate， inhibit inflammation， and regulate PG and G-17 levels in CAG patients， thus controlling or even reversing gastric mucosal atrophy and reducing the probability of its progression to gastric cancer.

Objective: To investigate the risk factors affecting the patency time of the125I seeds stent in malignant obstructive jaundice. Methods: A retrospective analysis of 113 patients with malignant obstructive jaundice underwent biliary tract125I seeds stent implantation. The gender, age, obstruction site, type of125I seeds stent, primary tumor type, and postoperative response to treatment of tumor were enrolled for analysis to evaluate the related risk factors affecting the patency time of the stent. Results: Univariate analysis showed that the location of biliary obstruction, the type of125I seeds stent, the type of primary tumor, and the type of primary tumor were the main factors affecting the patency time of the stent(P<0.001); Cox multivariate regression analysis showed biliary obstruction location, the type of125I seeds stent, and whether the primary tumor treated were independent factors that affected the patency time of the stent(P<0.001). Conclusion Multi-factor analysis shows that the location of biliary obstruction, the type of125I seeds stent, and the primary tumor are independent risk factors that affect the patency of the stent for malignant obstructive jaundice, which shows important markers for evaluating the prognosis of patients treated with this method.

Objective:To investigate the predictive value of diffusion tensor imaging (DTI) parameters in upper extremity motor function recovery after surgery in patients with acute cervical spinal cord injury (CSCI).Methods:Twenty-three patients with acute CSCI who received postoperative systemic rehabilitation therapy in Department of Neurosurgery, 900 th Hospital of Joint Logistics Team of People's Liberation Army from May 2019 to July 2021 were selected as an experimental group, and 22 healthy subjects (healthy control group) matched with age and gender were selected from Physical Examination Center of the same hospital at the same period. Routine MRI sequence and DTI scan of the cervical spinal cord, scale of American Association for Spinal Cord Injury (ASIA) and modified Barthe index (mBI) were performed in patients of the experimental group 1 d and 3 months after surgery. Routine MRI sequence and DTI scan of the cervical spinal cord were performed in healthy subjects after enrollment. The DTI parameters in different regions between the two groups were compared, and the differences in DTI parameters, ASIA scores and mBI in patients of the experimental group before and after surgery were compared. Correlations of preoperative DTI parameters with preoperative upper extremity motor ASIA scores and upper extremity motor recovery rate 3 months after surgery were analyzed by Pearson correlation analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of preoperative fractional anisotropy (FA) in upper extremity motor function recovery in CSCI patients 3 months after surgery. Results:As compared with the healthy control group, the experimental group had significantly lower preoperative FA in the injury area and distal injury area, and statistically higher preoperative apparent diffusion coefficient (ADC, P<0.05). In patients of the experimental group, preoperative FA in the injury area was significantly lower and ADC in the injury area was significantly higher as compared with those in the distal injury area ( P<0.05); patients of the experimental group had significantly higher FA in these two regions, upper extremity motor ASIA scores and mBI, and significantly lower ADC 3 months after surgery as compared with those 1 d before surgery ( P<0.05). The preoperative FA in the injury area and distal injury area in CSCI patients were positively correlated with preoperative upper extremity motor ASIA scores and upper extremity motor recovery rate 3 months after surgery ( P<0.05). ROC curve results showed that the area under the curve (AUC) of preoperative FA in injury area in predicting upper extremity motor function recovery 3 months after surgery was 0.912 ( 95%CI: 0.783-1.000, P<0.001); that of preoperative FA in the distal injury area was 0.842 ( 95%CI: 0.682-1.000, P<0.001). Conclusion:DTI parameters FA and ADC are sensitive indicators for detecting CSCI; preoperative FA in the injury area and distal injury area can be used to predict the upper extremity motor function recovery, but the efficacy of the former is superior to that of the later.

Objective To investigate the clinical efficacy and safety of wedge osteotomy combined with internal fixation for ulnar olecranon fracture of Mayo type ⅡB.Methods From July 2014 to December 2017,8 patients with ulnar olecranon fracture of Mayo type ⅡB were treated with wedge osteotomy of the ulnar olecranon combined with internal fixation.They were 6 men and 2 women,from 28 to 45 years of age (mean,31.4 years).The wedge osteotomy was planned preoperatively according to the literature data and the osteotomy lengths were measured postoperatively to confirm the safe range for the surgery.Fracture healing was evaluated by regular X-ray follow-up and therapeutic effects were assessed by the range of elbow motion and the Broberg-Morry scoring system.Results On average in this group,the olecranon osteotomy was 6.2 mm in length on the articular sudace and 14.5 mm at the basal part.The olecranon was shortened by 4.6 cm on average after operation.All the 8 patients were followed up for 14 to 20 months (average,16.4 months).The clinical fracture healing time ranged from 12 to 16 weeks,with an average of 14.3 weeks.Follow-ups revealed no fracture displacement,pain or internal fixation failure.No significant differences were found between the affected and the contralateral sides in the flexion,extension or range of motion of the elbow joint at 3 months or at one year after surgery (P ＞ 0.05).According to the Broberg-Morry scoring system,5 cases were rated as excellent,2 as good and one as fair at 3 months after surgery.The final follow-ups found no traumatic arthritis or joint instability.Conclusions As a new treatment alternative,wedge osteotomy combined with internal fixation can obtain satisfactory curative outcomes for ulnar olecranon fractures of Mayo type ⅡB.The wedge osteotomy was performed in a safe range for this group.

Objective To investigate the risk factors of delirium in elderly patients with intertrochanteric fracture after internal fixation.Methods The data of 160 patients with intertrochanteric fractures who received internal fixation in our hospital from January 2012 to July 2014 were analyzed retrospectively.The risk factors such as age,sex,preoperative complications,preoperative cognitive function,fracture location,operation mode,operation time,anesthesia method,hospital-to-operation time and intraoperative blood loss were summarized.Results The incidence of postoperative delirium was 28.15％ in postoperative elderly patients with intertrochanteric fractures.Univariate analysis showed that delirium had correlated with preoperative cognitive impairment,preoperative preparation time,serum sodium,fentanyl,atrial fibrillation,anesthesia method,operation time and perioperative blood loss (P ＜ 0.05).The multivariate Logistic regression analysis showed that the independent risk factors of postoperative delirium were preoperative cognitive dysfunction,operative time more than 2 hours and preoperative preparation time more than 4 days.Conclusion The occurrence of postoperative delirium was associated with anesthesia method,cognitive deficits,preoperative preparation time and perioperative blood loss.The anesthesia method which had less effect on the whole body condition and less time of operation preparation can decrease the occurrence of postoperative delirium in a certain extent,which is conducive to improving the prognosis.

Objective The primary aim of this study was to examine the proportion and natural history of Helicobacter pylori (Hp) negative bleeding peptic ulcers. Methods The study was designed as a multiple-center, case-control study conducted in 14 endoscopy centers in China from April 2006 to March 2007. Each center was expected to recruit 30 peptic ulcer patients with bleeding ( PUB group) and 30 without (PU group). All screened patients with upper gastrointestinal bleeding received endoscopy within 24 hours of admission. Biopsy specimens were taken from the antrum to determine Hp infection by rapid urease test and pathology. Patients with negative Hp infection at first examination were asked to receive urease breathe test (UBT) one month later. Results A total of 617 patients were enrolled with 263 in PUB group and 354 in PU group. There is no significant difference in demographic characters between 2 groups ( P ＞0. 05). The rate of Hp infection in PUB group ( 161/263, 61.2% ) was significantly lower than that in PUgroup (311/354, 87. 9%, P ＜0. 001 ). The incidence of complex ulcer in Hp positive PUB patients was 7.5% ( 12/161 ), which is significantly higher than that in Hp negative PUB patients ( 1/102, 1.0% , P =0. 018). In PUB group, no significant differences were found between Hp positive and negative patients in regarding of age, sex, rates of haematemesis, duodenal ulcer and gastric ulcer, and size of ulcer ( P ＞0. 05 ). Among 102 Hp negative cases in PUB, no positive case was found in UBT one month later. Conclusion We have demonstrated a rise in the incidence of Hp negative bleeding ulcers in China. The idiopathic ulcer was not rare, and might have a higher tendency to cause bleed.