Mental state is an important part of the normal life activities of the human body, and it is also the most external expression and the most easily obtained information of the physical condition. The normal activities of the mind depend on the normal operation of the viscera, qi, and blood, and are a unified whole that prospers together and suffers together. The theory of the five-spirit-viscera in the Yellow Emperor’s Inner Classic revealed that the normal mental activities of the human body were dominated by the five internal organs, that is, the five internal organs were the body and the five spirits were the function. And it highlighted the viewpoint that the five internal organs store the spirits and are actually one. The heart governs the spirit and belongs to the four internal organs. On this basis, Synopsis of Golden Chamber used the internal organs to diagnose and treat mental diseases, integrating the theory of the five spirits into it, forming a unique method of diagnosis and treatment with the heart as the leading factor and regulating the qi and blood of the four internal organs. It identified the pathogenesis of diseases such as pathogenic crying, lily disease, and hysteria from five levels: heart deficiency and weak qi, heart-lung disharmony, heart-liver disharmony, the heart of the loss of the spleen nourishment, and disharmony between heart and kidney. The treatment was mainly to replenish the deficiency of the viscera and eliminate the pathogens, reflecting the characteristics of regulating the mind and calming the four internal organs. This unique view on diagnosis and treatment has profoundly influenced the diagnosis and treatment theories of mental illnesses by later doctors, and is of great significance to the current clinical treatment of such illnesses.

Objective:To explore the efficacy and safety profile of sofosbuvir/velpatasvir/voxilaprevir ± ribavirin (SOF/VEL/VOX±RBV) for salvage treatment of chronic hepatitis C patients who have failed direct-acting antivirals (DAAs).Methods:Patients with chronic hepatitis C who failed DAAs±RBV treatment and were treated in five hospitals in Chongqing, Guangdong, Guizhou, and Guangxi from January 2022 to December 2023 were included in this retrospective study. One or more courses of DAAs±RBV therapy were evaluated for all patients who had been previously treated. Virological rebound occurrence was observed during the follow-up. SOF/VEL/VOX±RBV was used for one course of salvage treatment. Virological and biochemical indicators were analyzed before salvage therapy, post-treatment, and drug discontinuation at 12 weeks. Adverse drug events were recorded during treatment. Data between groups were compared using t-tests or non-parametric tests.Results:A total of 26 cases of chronic hepatitis C who had failed DAAs±RBV were included in this study, with an age of (52.9±9.6) years. Twenty-one cases (80.8%) were male, sixteen (61.5%) had a history of drug abuse, two (7.7%) had combined human immunodeficiency virus infection, and fourteen (53.8%) had combined cirrhosis. The previous DAA regimen of 21 cases (80.8%) included SOF/VEL. The baseline HCV RNA load of salvage treatment was (5.8±1.6) log 10 IU/ml, and 16 cases (61.5%) were genotype 3. All patients completed the 12-week SOF/VEL/VOX±RBV salvage treatment and achieved sustained virological response (SVR) at the end of treatment. All 22 cases were followed up for 12 weeks following treatment completion and attained SVR12, including patients with genotype 3 and cirrhosis. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) had normalized return rates of 94.1% and 93.8%, respectively, following therapy. ALT, AST, FIB-4 index, APRI, and aPMAP scores were significantly lower than those before treatment ( Z=-3.980, -3.875, -3.461, -3.582, P<0.05). The proportion of patients in the high-risk group of liver cancer dropped (52.6% before treatment and 33.3% after treatment), and more patients were reclassified to medium-and low-risk groups. Two cases (7.7%) experienced nausea and diarrhea, one case (3.8%) had a headache, and one case (3.8%) had fatigue, all of which were well managed during treatment. There were no serious adverse events, deaths, or interruptions of treatment due to adverse reactions. Conclusions:SOF/VEL/VOX is a safe and effective salvage treatment option for chronic hepatitis C patients who have failed DAAs therapy, and may be particularly beneficial to refractory populations infected with genotype 3 and combined with cirrhosis.

Objective:To explore the efficacy and safety profile of sofosbuvir/velpatasvir/voxilaprevir ± ribavirin (SOF/VEL/VOX±RBV) for salvage treatment of chronic hepatitis C patients who have failed direct-acting antivirals (DAAs).Methods:Patients with chronic hepatitis C who failed DAAs±RBV treatment and were treated in five hospitals in Chongqing, Guangdong, Guizhou, and Guangxi from January 2022 to December 2023 were included in this retrospective study. One or more courses of DAAs±RBV therapy were evaluated for all patients who had been previously treated. Virological rebound occurrence was observed during the follow-up. SOF/VEL/VOX±RBV was used for one course of salvage treatment. Virological and biochemical indicators were analyzed before salvage therapy, post-treatment, and drug discontinuation at 12 weeks. Adverse drug events were recorded during treatment. Data between groups were compared using t-tests or non-parametric tests.Results:A total of 26 cases of chronic hepatitis C who had failed DAAs±RBV were included in this study, with an age of (52.9±9.6) years. Twenty-one cases (80.8%) were male, sixteen (61.5%) had a history of drug abuse, two (7.7%) had combined human immunodeficiency virus infection, and fourteen (53.8%) had combined cirrhosis. The previous DAA regimen of 21 cases (80.8%) included SOF/VEL. The baseline HCV RNA load of salvage treatment was (5.8±1.6) log 10 IU/ml, and 16 cases (61.5%) were genotype 3. All patients completed the 12-week SOF/VEL/VOX±RBV salvage treatment and achieved sustained virological response (SVR) at the end of treatment. All 22 cases were followed up for 12 weeks following treatment completion and attained SVR12, including patients with genotype 3 and cirrhosis. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) had normalized return rates of 94.1% and 93.8%, respectively, following therapy. ALT, AST, FIB-4 index, APRI, and aPMAP scores were significantly lower than those before treatment ( Z=-3.980, -3.875, -3.461, -3.582, P<0.05). The proportion of patients in the high-risk group of liver cancer dropped (52.6% before treatment and 33.3% after treatment), and more patients were reclassified to medium-and low-risk groups. Two cases (7.7%) experienced nausea and diarrhea, one case (3.8%) had a headache, and one case (3.8%) had fatigue, all of which were well managed during treatment. There were no serious adverse events, deaths, or interruptions of treatment due to adverse reactions. Conclusions:SOF/VEL/VOX is a safe and effective salvage treatment option for chronic hepatitis C patients who have failed DAAs therapy, and may be particularly beneficial to refractory populations infected with genotype 3 and combined with cirrhosis.

Objective: To investigate the potential risk factors for influencing renal recovery at discharge in critically ill patients with acute kidney injury (AKI) requiringcontinuous renal replacement therapy (CRRT). Methods: This was a single-center, retrospective study. Critically ill patients with AKI requiring CRRT adimitted to the Department of Intensive Care Unit (ICU) in Taizhou Municipal Hospital, Zhejiang province, from June 2014 to December 2017 were included and divided into two groups according to the status of renal recovery at discharge as renal recovery group and renal non-recovery group. The data of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score at adimission to ICU, initial serum creatinine (initial SCr) and lactate level and initial estimated glomerular filtration rate (initial eGFR) at time of AKI diagnosis, and total time of RRT and duration of anuria before CRRT were analyzed. Length of ICU stay and length of hospital stay in both groups were also analyzed. Multivariate logistic regression was taken to analyze the potential risk factors for influencing renal recovery at discharge in critically ill patients with AKI. Results: A total of 115 critically ill patients with AKI requiring CRRT were included, of which whom 45 cases were in renal recovery group and 70 cases were in renal non-recovery group, and the renal recovery rate at discharge was 39.1%(45/115); 59 patients were dead during hospitalization and the hospital mortality was 51.3%(59/115). Compared with renal non-recovery group, renal recovery group have a lower value of APACHEⅡ score [(21.73 ± 2.66) scores vs. (23.19 ± 4.41) scores, P=0.03), SOFA score [(11.02 ± 2.22) scores vs. (12.79 ± 2.82) scores, P=0.001], lactate level [(3.82 ± 1.34) mmol/L vs. (4.47 ± 1.52) mmol/L, P=0.021], initial SCr [(2.151 ± 0.677) mg/dl vs. (2.505 ± 0.792) mg/dl, P=0.015], duration of anuria before CRRT[(11.80 ± 4.71) h vs. (19.11 ± 5.98) h, P=0.005] and total time of RRT [(8.64 ± 3.42) d vs. (15.81 ± 5.07) d, P=0.001], and have a higher value of initial eGFR [(36.26 ± 14.74) ml/(min·1.73 m²) vs. (30.07 ± 10.38) ml/(min·1.73 m²), P=0.009]. In addition, length of ICU stay [(12.58 ± 4.78) d vs. (15.30 ± 5.45) d, P=0.007] and length of hospital stay [(19.58 ± 6.44) d vs. (22.11 ± 5.90) d, P=0.032] in renal recovery group were also significantly lower than those in renal non-recovery group. Multivariate logistic regression analysis indicated that SOFA score (OR=0.700, 95% CI 0.521-0.941, P=0.018), duration of anuria before CRRT (OR=0.782, 95%CI 0.689-0.888,P < 0.01) and total time of RRT (OR=0.673, 95% CI 0.565-0.801; P < 0.01) were independent risk factors influencing renal recovery at discharge in critically ill patients with AKI, and initial eGFR was a independent protective factor. Conclusions As to critically ill patients with AKI requiring CRRT, there are many factors that affect renal recovery at discharge,. SOFA score, duration of anuria before CRRT and total time of RRT are independent risk factors, and initial eGFR is an independent protective factor.

Objective Using middle cerebral artery occlusion (MCAO) model to observe protective effect of effective components of bezoar on brain damage.To discuss the anti-cerebral ischemia mechanism and compare the efficacy of effective components of bezoar from the endoplasmic reticulum stress intervention angle.Methods Rats were stratified randomly divided into sham group,model group,Qingkailing group (positive drug,3 mL/kg),taurine group,ursodeoxycholic acid (UDCA,78 mg/kg) group,taurine-conjugated ursodeoxycholic acid (TUDCA,100 mg/kg) group.Through establish MCAO model in rats,observed the scores of the neurologic impairment,measured infarct volume by TTC.Immunohistochemistry and Western blotting were Used to detect the content of P-PERK,P-EIF2α,and ATF4.Results Compared with sham group,neurologic impairment scores of model group significantly reduced (P ＜ 0.01).Compared with model group,Qingkailing group,UDCA group,and TUDCA group significantly improved neurological function in rats (P ＜ 0.05,0.01).Compared model group,all the treatment groups could significantly reduce the volume of cerebral infarction (P ＜ 0.01).Compared with sham group,expression of P-PERK,P-EIF2α,and ATF4 was significantly increased (P ＜ 0.01).Compared with model group,all the treatment groups reduced the expression of P-PERK,P-EIF2α,and ATF4 in varying degrees,effect of Qingkailing and TUDCA were more obvious.Conclusion The effective components ofbezoar alleviate cerebral ischemia reperfusion injury in rats by inhibiting endoplasmic reticulum stress,the effect of TUDCA is better than that of taurine and UDCA.

Objective:To establish the methods for the qualitative identification and content determination of aurantio-obtusin and chrysophanol in Zeju Jiangzhi tablets. Methods:A TLC method was adopted for the qualitative identification, and an HPLC method was used for the content determination. The determination was performed on a Wondasil C18 (250 mm × 4. 6 mm, 5 μm ) column with the mobile phase of acetonitrile -0. 1% phosphonic acid with gradient elution at the flow rate of 1. 0 ml?min-1 , the detection wave-length was 286 nm, the column temperature was 30℃ and the injection volume was 10μl. Results:The TLC spots of aurantio-obtusin and chrysophanol were clear and well-separated without any negative interference. The HPLC experiment results showed the good line-arity within the range of 1. 03-25. 72μg?ml-1(r=0. 999 9) for aurantio-obtusin, and 0. 48-11. 92μg?ml-1(r=0. 999 9) for chry-sophanol. The average recovery was 99. 21% and 98. 85%, and RSD was 0. 70% and 0. 73%, respectively (n=9). Conclusion:The method is simple, accurate and repeatable, which can be used for the qualitative identification and content determination of auran-tio-obtusin and chrysophanol in Zeju Jiangzhi tablets.

OBJECTIVETo identify the risk factors associated with the severity of pulmonary embolism among patients with deep venous thrombosis of lower extremities.

METHODSThis prospective study enrolled 208 patients with acute deep venous thrombosis to screen for pulmonary embolism between July 2010 and July 2012 in Beijing Shijitan Hospital. There were 101 male and 107 female patients, with a mean age of (59 ± 16) years. Gender, age, extension, side of lower extremities of deep venous thrombosis was analyzed by χ² test. Ordinal Logistic regression was used to determine risk factors associated with severity of pulmonary embolism.

RESULTSThere were 83 patients with iliofemoral deep venous thrombosis, 102 patients with femoropopliteal and 23 patients with calf deep venous thrombosis. Pulmonary embolism was detected in 70 patients with the incidence of 33.7%. Pulmonary embolism was significantly correlated with extension (χ² = 17.286, P = 0.004) and sides (χ² = 15.602, P = 0.008) of deep venous thrombosis, not with age (χ² = 7.099, P = 0.260), gender (χ² = 7.014, P = 0.067), thrombotic risk factors (χ² = 3.335, P = 0.345) in univariate analysis. Results of multivariate ordinal logistic regression showed that iliofemoral vein thrombosis (OR = 6.172, 95% CI: 1.590 to 23.975, P = 0.009) and bilateral venous thrombosis (OR = 7.140, 95% CI: 2.406 to 24.730, P = 0.001) are associated with more serious pulmonary embolism.

CONCLUSIONSIncidence of pulmonary embolism is still high in patients with deep venous thrombosis. Extensive iliofemoral and bilateral vein thrombosis may increase risk of severity of pulmonary embolism. Clinicians should pay more attention to these high-risk patients.

Acute Disease ; Adult ; Aged ; Female ; Humans ; Incidence ; Logistic Models ; Lower Extremity ; pathology ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Embolism ; diagnosis ; pathology ; Risk Factors ; Veins ; pathology ; Venous Thrombosis ; diagnosis ; pathology

Objective To investigate onthe correlation between the seven single nucleotide polymorphisms and genesis of T2DM. Methods High‐resolution melting (HRM ) curve technology was used to detect thegenotype of the seven SNPs in 202 T2DM patients and 200 healthy volunteers. The relationship between susceptible gene polymorphism and T 2DM was analyzed. Results The frequency of five SNP loci rs8050136 ,rs13266634 ,rs7578597 ,rs864745 and rs7961581 showed significant differences between T2DM patients and controls ( P< 0.01 ). The OR of rs8050136 ,rs13266634 ,rs757859 and rs864745 was >1 ,while OR of rs7961581 was <1. There was no significant difference in rs10811661 and rs10923931 loci between T2DM patients and controls (OR=1). Conclusion The polymorphism of loci rs8050136 ,rs13266634 ,rs7578597 and rs864745 is associated with T2DM genesis in this study population , while rs10811661 and rs10923931 is not associated with T 2DM genesis ,and rs7961581 may be a protective factor for T2DM.

OBJECTIVETo investigate the influence of different pressures of CO2 pneumoperitioneum on pathomorphism and function of intestines following laparoscopic gastrectomy (LG).

METHODSForty-eight gastric cancer patients were prospectively enrolled in the study. Among them, 36 patients scheduled for elective LG were randomly assigned to low pressure group (LP), middle pressure (MP), and high pressure group (HP) with 12 cases in each group. The CO2 pneumoperitoneum pressure was maintained at 8-10 mmhg in LP, 11-13 mmhg in MP, and 14-16 mmhg in HP. The control group was open gastrectomy group (OG) in 12 cases. The intestinal pathomorphism and level of plasma D-lactic acid before, during and after operation, and postoperative intestinal function of four groups were examined and compared.

RESULTSThere were no statistical differences in preoperative data among the four groups(all P>0.05). LG group was associated with a lower rate of surgical complications than OG (8.3% vs. 41.7%, P<0.05). No obvious damage of intestinal mucosa was found in OG group. Damage degree of intestinal mucosa after operation in LP, MP and HP groups was 0-1, 1-2, and 2-3 respectively. There was significant change in intestinal pathomorphism after operation in both HP and MP groups. The levels of D-lactic acid before operation were not significantly different among all the four groups, but increased significantly in each group after operation (all P<0.05). HP group had the highest level of plasma D-lactic acid and presented with delayed bowel sound return (4.5 d), time to first flatus (5.4 d), and intake (6.0 d) as compared to the other 3 groups (all P<0.05).

CONCLUSIONSLaparoscopic radical gastrectomy is safe and minimally invasive. Higher pneumoperitoneal pressure is harmful to the recovery of intestinal mucosa and function. Therefore the pneumoperitioneum pressure should be maintained as low as possible under clear visualization during operation.

Gastrectomy ; Humans ; Intestines ; physiology ; Laparoscopy ; Pressure ; Stomach Neoplasms ; surgery