This paper discussed the clinical ideas and methods of treating diabetes by improving symptoms. Diabetes-related symptoms can affect the control of blood glucose and other metabolic indicators to varying degrees， and affect the quality of life of patients. In the clinical diagnosis and treatment of diabetes， “equal emphasis on both indicators” is suggested， meaning that quality of life indicators is as important as metabolic indicators. The patient's symptoms should be paied attention to， and the diagnosis and treatment should start from “symptom differentiation”， and emphasize the “key symptoms”. When there are many symptoms， it is advised to adopt the combined treatment mode of “syndrome cluster”， and take the principle of “treating both the root and accompanying symptoms in mild cases with multiple symptoms， and prescribing multiple formulas daily”. At the same time， the model of co-management of three disciplines of diabetes consisting of diabetes specialists， traditional Chinese medicine doctors， and health managers can help the management of diabetes symptoms.

Objective To analyze the effect of Xiaozhi Decoction in the treatment of hyperlipidemiain different classification of physical constitution in TCM.Methods We screened 206 patients with Hyperlipidemia in our hospital and had been treated with drugs during May 2020 to March 2023.Totally 103 patients in the TCM group were treated with Xiaozhi Decoction,103 patients in the western medicine group were treated with atorvastatin.Selected total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and liver transaminase before and after a period of treatment.The non-high-density lipoprotein cholesterol(non-HDL-C)will be calculated,too.Results In the Phlegm-Dampness constitution,TC,TG,LDL-C and non-HDL-C decreased significantly all in the TCM group(P<0.05);TC,TG and non-HDL-C decreased significantly all in the western medicine group(P<0.05).The TCM group is superior to the western medicine group in TC,LDL-C,non-HDL-C(P<0.05).In the Qi-Deficiency constitution,TC,TG,LDL-C and non-HDL-C decreased significantly all in the TCM group(P<0.05);TC,LDL-C and non-HDL-C decreased significantly all in the western medicine group(P<0.05).The TCM group is superior to the western medicine group in non-HDL-C(P<0.05).In the Blood-Stasis constitution,TC,TG,LDL-C and non-HDL-C decreased significantly all in the western medicine group only(P<0.05).The western medicine group is superior to the TCM group in TC,LDL-C,non-HDL-C(P<0.05).In the Yin-Yang Harmony constitution,TC and non-HDL-C decreased significantly both in the TCM group(P<0.05).TC,LDL-C and non-HDL-C decreased significantly all in the western medicine group(P<0.05).The western medicine group is superior to the TCM group in TC,LDL-C,non-HDL-C(P<0.05).Conclusion Xiaozhi Decoction is superior to the the atorvastatin in the treatment of hyperlipidemia for the Phlegm-Dampness constitution and Qi-deficiency constitution groups.But it is not superior to the atorvastatin in the treatment of hyperlipidemia for the Blood-Stasis constitution and Yin-Yang Harmony constitution groups.

Objective To explore the effects and possible mechanisms of ophthalmic acupuncture combined with tail moxibustion on the behavior and hippocampus in rats with post-stroke cognitive impairment.Methods Seventy-five male SD rats were randomly divided into the sham operation group (15 rats) and the modeling group (60 rats) using the random number table method. A modified suture-occluded method was used to replicate the occlusion model of the middle cerebral artery in the modeling group,whereas only the right carotid artery was exposed in the sham operation group. After modeling,48 rats with post-stroke cognitive impairment were selected using the Morris water maze experiment,and were randomly divided into the model group,the ophthalmic acupuncture group,the tail moxibustion group and the ophthalmic acupuncture+tail moxibustion group using the random number table method,with 12 rats per group. The sham operation group and the model group were bound with no intervention;the ophthalmic acupuncture group was needled once a day in the bilateral "liver area","kidney area","heart area",and "spleen area",leaving the needle for 30 min;the tail moxibustion group was given mild-warm moxibustion on the area between "Changqiang" (GV1) and the tip of the tail for 20 min,once a day;the ophthalmic acupuncture+tail moxibustion group was given the above-mentioned ophthalmic acupuncture and tail moxibustion interventions simultaneously. After 7 days of intervention,the behavior of the rats was detected. Hematoxylin and eosin staining was used to observe the pathological changes in the hippocampus;the malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in the hippocampus were detected by colorimetric method;Western blotting was used to detect the protein expressions of Kelch-like ECH associated protein 1 (KEAP1),phosphoglycerate mutase 5 (PGAM5),apoptosis-inducing factor mitochondria associated 1 (AIFM1),nuclear factor erythroid 2-related factor 2 (Nrf2),and heme oxygenase-1 (HO-1) in the hippocampus of rats;and real-time fluorogenic quantitative PCR was used to determine the mRNA expressions of KEAP1,PGAM5,AIFM1,Nrf2,and HO-1 in the hippocampus. Results Compared with the sham operation group,the escape latency in the model group was prolonged,and the crossing platform number was decreased (P<0.05);the number of neurons in the hippocampal CA1 area was significantly decreased,with a disordered arrangement and irregular morphology,and necrotic neurons were observed;the SOD activity in the hippocampus was decreased,while the MDA content was increased (P<0.05);the protein and mRNA expressions of KEAP1,PGAM5,and AIFM1 were increased,while the protein and mRNA expressions of Nrf2 and HO-1 were decreased (P<0.05). Compared with the model group,the escape latency of rats in the ophthalmic acupuncture+tail moxibustion group was shortened,and the crossing platform number was increased (P<0.05);the loss of neurons in the hippocampal CA1 area of the rat was significantly reduced,and the cell morphology was more plump;SOD activity in the hippocampus was increased,and MDA content was decreased (P<0.05);and the protein and mRNA expressions of KEAP1,PGAM5,and AIFM1 were decreased,while the protein and mRNA expressions of Nrf2 and HO-1 were increased (P<0.05).Conclusion The combination of ophthalmic acupuncture and tail moxibustion can be used to treat rats with post-stroke cognitive impairment,and its mechanism may be related to alleviating oxidative stress damage and oxeiptosis in the hippocampus,thereby improving the degree of hippocampal neuronal damage and enhancing the cognitive ability of rats after stroke.

Background::Triple-negative breast cancer (TNBC) is a type of highly invasive breast cancer with a poor prognosis. According to new research, long noncoding RNAs (lncRNAs) play a significant role in the progression of cancer. Although the role of lncRNAs in breast cancer has been well reported, few studies have focused on TNBC. This study aimed to explore the biological function and clinical significance of forkhead box C1 promoter upstream transcript (FOXCUT) in triple-negative breast cancer.Methods::Based on a bioinformatic analysis of the cancer genome atlas (TCGA) database, we detected that the lncRNA FOXCUT was overexpressed in TNBC tissues, which was further validated in an external cohort of tissues from the General Surgery Department of the First Affiliated Hospital of Nanjing Medical University. The functions of FOXCUT in proliferation, migration, and invasion were detected in vitro or in vivo. Luciferase assays and RNA immunoprecipitation (RIP) were performed to reveal that FOXCUT acted as a competitive endogenous RNA (ceRNA) for the microRNA miR-24-3p and consequently inhibited the degradation of p38. Results::lncRNA FOXCUT was markedly highly expressed in breast cancer, which was associated with poor prognosis in some cases. Knockdown of FOXCUT significantly inhibited cancer growth and metastasis in vitro or in vivo. Mechanistically, FOXCUT competitively bounded to miR-24-3p to prevent the degradation of p38, which might act as an oncogene in breast cancer. Conclusion::Collectively, this research revealed a novel FOXCUT/miR-24-3p/p38 axis that affected breast cancer progression and suggested that the lncRNA FOXCUT could be a diagnostic marker and therapeutic target for breast cancer.

Objective:To investigate the safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia.Methods:Data of acute ischemic stroke patients with baseline National Institutes of Health Stroke Scale(NIHSS)score≤3 and a platelet count<100×109/L were obtained from a multicenter register.Those who required anticoagulation or had other contraindications to antiplatelet therapy were excluded.Short-term safety outcomes were in-hospital bleeding events,while the long-term safety outcome was a 1-year all-cause death.The short-term neurological outcomes were evaluated by modified Rankin scale(mRS)score at discharge.Results:A total of 1868 non-cardioembolic mild stroke patients with thrombocytopenia were enrolled.Multivariate regression analyses showed that mono-antiplatelet therapy significantly increased the proportion of mRS score of 0-1 at discharge(OR=1.657,95%CI:1.253-2.192,P<0.01)and did not increase the risk of intracranial hemorrhage(OR=2.359,95%CI:0.301-18.503,P>0.05),compared with those without antiplatelet therapy.However,dual-antiplatelet therapy did not bring more neurological benefits(OR=0.923,95%CI:0.690-1.234,P>0.05),but increased the risk of gastrointestinal bleeding(OR= 2.837,95%CI:1.311-6.136,P<0.01)compared with those with mono-antiplatelet therapy.For patients with platelet counts≤75×109/L and>90×109/L,antiplatelet therapy significantly improved neurological functional outcomes(both P<0.05).For those with platelet counts(>75-90)×109/L,antiplatelet therapy resulted in a significant improvement of 1-year survival(P<0.05).For patients even with concurrent coagulation abnormalities,mono-antiplatelet therapy did not increase the risk of various types of bleeding(all P>0.05)but improved neurological functional outcomes(all P<0.01).There was no significant difference in the occurrence of bleeding events,1-year all-cause mortality risk,and neurological functional outcomes between aspirin and clopidogrel(all P>0.05).Conclusions:For non-cardioembolic mild stroke patients with thrombocytopenia,antiplatelet therapy remains a reasonable choice.Mono-antiplatelet therapy has the same efficiency as dual-antiplatelet therapy in neurological outcome improvement with lower risk of gastrointestinal bleeding.

Objective:To investigate the clinical efficacy and safety of transcervical non-inflatable endoscopic thyroidectomy through the posterior inferior sternocleidomastoid approach. Methods:From December 2022 to May 2023, the clinical data of 35 patients with papillary thyroid carcinoma treated by transcervical non-inflatable endoscopic surgery via posterior inferior sternocleidomastoid approach were retrospectively analyzed. There were 14 males and 21 females, with an average age of 44.7 years. The operation time, bleeding volume, postoperative recovery, complications and follow-up were recorded. Results:All 35 patients successfully completed the surgery, with an average operation time of 4 hours and 7 minutes, an average bleeding volume of 14 ml, and an average postoperative hospital stay of 3.5 days. There were no serious complications and no obvious neck discomfort during postoperative follow-up. Conclusion:Transcervical non-inflatable endoscopic thyroidectomy via posterior inferior sternocleidomastoid approach is safe and effective, with fast postoperative recovery,high appearance satisfaction and good neck comfort.
Female ; Male ; Humans ; Adult ; Retrospective Studies ; Neck ; Neck Muscles/surgery* ; Thyroid Neoplasms/surgery*

OBJECTIVE: To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. METHODS: A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). RESULTS: Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences ( P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). And there was no significant difference between the two groups at each time point after operation ( P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months ( P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group ( P<0.05). CONCLUSION For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.
Humans ; Spinal Stenosis/surgery* ; Low Back Pain/surgery* ; Blood Loss, Surgical ; Intervertebral Disc Displacement/surgery* ; Lumbar Vertebrae/surgery* ; Retrospective Studies ; Spinal Fusion

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.

Objective:To evaluate the reliability and validity of the Chinese version of behavioral activation for depression scale (C-BADS) in patients in methadone maintenance treatment (MMT).Methods:A total of 162 opioid addicts were recruited from the MMT programs in Wuhan city for the C-BADS investigation.Items analysis and exploratory factors analysis (EFA) were conducted with SPSS 21.0 and confirmatory factors analysis (CFA) was conducted with AMOS 24.0.Results:The correlation coefficients between subscales and total score were 0.228-0.813 (all P<0.01). Except for activation subscale, the correlation coefficients among subscales were lower than those between subscale dimensions and total score.The item-total score correlations coefficient were 0.060-0.716.Four factors were extracted by EFA, named avoidance/rumination(AR), activation(AC), social impairment(SI) and work/school impairment(WS) respectively, which the cumulative variance was 51.153%, and the factor loading of each item ranged from 0.328 to 0.797.The fitting indexes of CFA model were as following: χ 2/ df=1.594, CFI=0.839, TLI=0.820, IFI=0.844, RMSEA=0.069, SRMR=0.089.The Cronbach's α of the scale was 0.790, and the split-half reliability coefficient was 0.827. Conclusion:C-BADS has good internal consistency reliability and construct validity, but it still needs to be modified for the measurement of behavior activation of patients in MMT.

Gandou decoction (GDD), a well-known traditional Chinese medicine (TCM) formula, has been widely used for decades to treat Wilson's disease (WD) in China due to its remarkable clinical effects. However, the chemical constituents of GDD still remain unclear because of their complexity. In this work, a reliable and sensitive strategy based on ultra-performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MSE) and UNIFI informatics platform was applied to investigate the chemical components in GDD. In total, 96 compounds including anthraqui-nones, alkaloids, protostane triterpenoids, flavonoids, triterpenoid saponins, tannins, curcuminoids, etc, were identified or tentatively characterized from GDD by comparing their retention time, accurate mass within 5 ppm error and MSE fragmentation patterns. Among them, eleven compounds were confirmed unambiguously with reference standards. Representative compounds in different chemical structure types were analyzed in fragmentation patterns and characteristic ions. Moreover, to better understand the chemical contribution of individual herbs to the whole decoction, the corresponding each herb in GDD was also detected. This study developed a rapid method for characterizing the chemical constitu-ents in GDD, which could not only be used for chemical standardization and quality control, but also be helpful for further research of GDD in vivo.