By consulting ancient herbal books and modern literature， this paper systematically sorted out and researched the processing history， relevant processing norms in recent years， modern processing technology， chemical composition changes of processed products and their pharmacological mechanism of Scutellariae Radix， in order to provide a basis for the further development of Scutellariae Radix decoction pieces. According to the textual research of ancient books， there were many kinds of processing auxiliary materials of Scutellariae Radix， such as wine， vinegar， salt， honey， pig bile and so on， among which the wine processing was the most diverse and detailed， and the processed products such as raw products， stir-fried products， wine-processed products， fried charcoal products were still in use. The modern processing techniques of Scutellariae Radix mainly focus on the processing aspects of softening and slicing， wine processing and charcoal frying， and the research methods are relatively unified. At present， it is found that the changed chemical constituents of Scutellariae Radix after processing are flavonoids， polysaccharides， volatile oils and trace elements， etc. Pharmacological effects of processed products are hemostasis， antibacterial， anti-inflammatory， antioxidant， analgesic and antipyretic， treatment of lung diseases， treatment of colitis， etc. However， in the studies of Scutellariae Radix processing， there is a lack of research on the structural changes of chemical components caused by processing and a comprehensive comparative study on the pharmacological effects of various processed products. Based on this， it is suggested to carry out systematic research on the processing technology to processing mechanism， further explore the relationship between the change rule of material basis and pharmacological action before and after processing of Scutellariae Radix， and deepen the exploration of molecular mechanism and clinical application of processed products of Scutellariae Radix， in order to clarify the scientific connotation of the processing mechanism of Scutellariae Radix， and lay a foundation for the subsequent expansion of the application of Scutellariae Radix decoction pieces and the formulation of processing standards.

The American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the American Society of Regional Anesthesia and Pain Medicine collaborated to develop an evidence-based study about the safe and effective use of Ketamine in total joint arthroplasty(TJA). Based on the systematic review and Meta-analysis of several studies, the following conclusions are drawn: Ketamine can effectively relieve the postoperative pain of patients; Ketamine can effectively reduce the occurrence of postoperative nausea and vomiting; Ketamine can reduce the use of postoperative opioids; intraoperative use of Ketamine does not increase the incidence of postoperative adverse reactions. The above conclusions are graded according to the strength of evidence support. This article interprets the guidelines to provide reference for addressing the effectiveness and safety of Ketamine use in TJA.

Objective To investigate the correlation between genetic polymorphisms and the risk of rivaroxaban bleeding events in elderly patients with nonvalvular atrial fibrillation(NVAF).Meth-ods A total of 180 elderly NVAF patients treated with rivaroxaban in our department from June 2019 to June 2022 were enrolled,and after 1 year of follow-up,finally,167 patients were included,according to whether bleeding events occurred,they were divided into hemorrhage group(n=31)and control group(n=136).The clinical data and genetic polymorphism were compared between the two groups.Multivariate logistic regression was used to analyze the association between genet-ic polymorphisms and bleeding events in the patients after rivaroxaban treatment.Results Higher frequencies of CYP2C9*1,CYP2C9*3 and VKORC1-GG,but lower frequencies of CYP2C9*2,VKORC1-AA and VKORC1-AG were observed in the bleeding group than the control group(all P＜0.01).Multivariate logistic regression analysis showed that CYP2C9*1,CYP2C9*3 and VKORC1-GG were independent risk factors for bleeding events in elderly NVAF patients taking rivaroxaban(OR=1.880,95％CI:1.126-1.997,P=0.030;OR=1.432,95％CI:1.044-1.964,P=0.026;OR=2.176,95％CI:1.173-4.037,P=0.014),while,CYP2C9*2,VKORC1-AA and VKORC1-AG were protective factors for bleeding events in elderly NVAF patients taking rivar-oxaban.Conclusion Genetic polymorphisms of CYP2C9 and VKORC1 are significantly correlated with the risk of bleeding events in elderly NVAF patients taking rivaroxaban.And CYP2C9*1,CYP2C9*3 and VKORC1-GG genotypes are independent risk factors,while CYP2C9*2,VKORC1-AA and VKORC1-AG genotypes are protective factors.

Colorectal cancer is the most common malignant tumor of digestive tract, and BRAF V600E mutations occur in approximately 10% of patients with metastatic colorectal cancer (mCRC). Cancer patients harboring this mutation have a unique molecular profile and clinical phenotype; they show poor response to systemic chemotherapy, insensitivity to single BRAF inhibitor, and short survival rate. It is important to develop new therapeutic agents and clinical strategies to improve the prognosis of these patients. This review mainly introduces treatment methods for BRAF V600E-mutated mCRC and rationally derived combinations of targeted agents and immunotherapy.

This study was designed to investigate the effect of emodin(EMO)on endoplasmic reticulum stress(ERS)in alveolar macrophages(AMs)of rats with severe acute pancreatitis(SAP)and the underlying mechanism.Forty rats were recruited and randomized into four groups:sham-operation(SO)group,SAP group,4-phenylbutyric acid(4-PBA)group and EMO group.The SAP model was established by retrograde injection of 5%sodium taurocholate into the biliopancreatic duct.HE staining was performed to observe the pathological changes in the pancreas and lung;the wet/dry weight ratio of lung tissue was calculated.Arterial partial pressure of the oxygen(PaO2)and carbon dioxide(PaCO2)were measured;the serum amylase activity and the levels of inflammatory factors TNF-α and IL-6 were evaluated.TUNEL staining was used to determine the cell apoptosis rate of lung tissue;Western blot was used to detect the protein expression levels of GRP78,ATF6,CHOP,and Caspase-12.Moreover,rat AMs(NR8383)were signed into control(CON)group,lipopolysaccharide(LPS)group,4-phenylbutyric acid(4-PBA)group and EMO group in vitro.Glutathione(GSH)and malondialdehyde(MDA)levels in the cell medium were measured,as were the protein expression levels of GRP78,ATF6,CHOP,and Caspase-12 in AMs.For experiments in vivo,compared with the SO group,the pathological score of pancreatic and lung in SAP rats was increased(P<0.05),the levels of serum amylase activity,IL-6 and TNF-α were increased(P<0.05),the wet/dry weight ratio and apoptosis rate of lung tissue were increased(P<0.05),PaO2 was decreased,PaCO2 was increased(P<0.05),and the protein expression of GRP78,ATF6,CHOP and Caspase-12 were increased in lung tissue(P<0.05).Compared with the SAP group,these indexes mentioned above in the 4-PBA and EMO groups were reversed(P<0.05).For experiments in vitro,compared with the CON group,GSH levels were decreased,and MDA levels were increased in the cell medium of LPS group(P<0.05),and the expression of GRP78,ATF6,CHOP and Caspase-12 proteins were upregulated(P<0.05).Compared with the LPS group,these indexes mentioned above in in cell medium of the 4-PBA and EMO groups were reversed(P<0.05).In conclusion,the protective effect of EMO on pancreatic and lung injury in SAP rats may be closely related to the inhibition of ATF6/CHOP pathway-induced inflammation and oxidative stress in AMs.

Objective:To explore the effect of multidisciplinary team cooperation intervention model on the fear of falling (FOF) of postoperative elderly patients during hospitalization.Methods:From January to December 2021, 100 elderly patients with FOF after surgery in the Surgical Ward of the International Medical Department of Peking Union Medical College Hospital were selected by convenient sampling. The patients were randomly divided into the control group and the observation group according to single and double numbers, with 50 cases each. The control group was given routine nursing, and the observation group was given multidisciplinary team cooperation intervention on the basis of routine nursing. The scores of the Modified Fall Efficacy Scale (MFES) were evaluated on the afternoon of the first day of the patient's getting out of bed (inclusion criteria) and the afternoon of the second day of the activity to compare the FOF of the two groups of elderly patients.Results:Before intervention, there was no statistical difference in MFES scores between the two groups ( P>0.05) . After intervention, the MFES score of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.01) . In the same Morse fall risk grade of low risk, medium high risk and high risk, the difference of MFES score in the observation group was higher than that in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:Multidisciplinary team cooperation intervention can effectively improve the FOF of elderly patients during hospitalization after surgery and promote postoperative rehabilitation.

OBJECTIVE: To estimate the social and economic burden of Downs syndrome for patients and their families residing in Changsha, China. METHODS: An 160-item self-administered questionnaire was designed and distributed to the primary caregivers of the patients in March 2020. A total of 81 eligible participants had completed the questionnaire, among which 20 were excluded for incomplete data. A patient perspective was taken to estimate the economic burden of the disease. The social impact of the disease on the patient's family was evaluated through questions adapted from the Stanford Psychological Wellbeing (PWB) Scale. RESULTS: The estimated life-course cost of a Downs syndrome patient in Changsha is 4 985 659 RMB, with the patient and caregiver's loss of income taking the greater proportion. In addition, as the majority of the patients' primary caregivers, female caregivers experienced not only considerable financial hardship caused by the care provision, but also a significant amount of psychological pressure and social discrimination. CONCLUSION Increased level of social welfare for the patients and social support for their female caregivers are essential for reducing economic burden and improving their quality of life in the area. In addition, prenatal screening and diagnosis for Downs syndrome are important for reducing both the social and economic burden of the disease by preventing its occurrence.
Caregivers ; China ; Down Syndrome ; Female ; Financial Stress ; Humans ; Quality of Life ; Social Discrimination ; Surveys and Questionnaires

OBJECTIVE: To compare the clinical application and health economic values of non-invasive prenatal testing (NIPT) and second trimester serum screening (STSS). METHODS: A retrospective analysis was carried out on 54 026 singleton pregnant women undergoing NIPT and STSS from March 1, 2018 to December 31, 2019 in Changsha Maternal and Child Health Care Hospital. For pregnant women with high-risk results of NIPT, prenatal diagnosis and follow-up of pregnancy outcomes were conducted. The data was grouped to 4 screening models, and their cost-benefit was analyzed. RESULTS: The sensitivity, specificity and positive predictive value of NIPT were all higher than STSS. Screening models 1 to 4 have prevented the birth of 71, 29, 52 and 54 patients with Down syndrome, respectively. The safety index of screening models 1 to 4 were 0.0036, 0.3944, 02215 and 0.1281, respectively. When the price of NIPT was decreased to 600 RMB, the cost-benefit of the screening models 1 to 4 was 0.46, 0.65, 0.44 and 0.40 million RMB, respectively. CONCLUSION NIPT has a better detection performance than STSS. When the price of NIPT is 600 RMB, screening model 1 has the best screening effect and the highest accuracy, safety index and health economical value.
Child ; China ; Cost-Benefit Analysis ; Down Syndrome/diagnosis* ; Female ; Humans ; Pregnancy ; Prenatal Diagnosis/methods* ; Retrospective Studies

Objective:To evaluate the effect of nimodipine on postoperative cognitive function in elderly patients undergoing carotid endarterectomy.Methods:Eighty-two American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 65-80 yr, scheduled for elective carotid endarterectomy under general anesthesia, were divided into 2 groups ( n=41 each) using a random number table method: control group (group C) and nimodipine group (group N). Nimodipine 7.5 μg·kg -1·h -1 was intravenously infused starting from the beginning of surgery until the end of surgery in group N, while the equal volume of normal saline was given in group C. Before infusing nimodipine (T 1), before placing the the shunt (T 2), at 10 min after placing the the shunt (T 3) and at 10 min after releasing carotid artery (T 4), blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Jugular venous blood oxygen content, arterio-jugular difference of oxygen content, and cerebral oxygen extraction ratio were calculated.The concentrations of S100β protein in serum of the jugular bulb were measured by enzyme-linked immunosorbent assay.Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) Scale (Chinese version) at 1 day before surgery and 1, 3 and 7 days after surgery, and the occurrence of cognitive dysfunction (MoCA score<26) was recorded within 7 days after operation. Results:Compared with group C, MoCA scores were significantly increased at each time point after surgery, and the incidence of cognitive dysfunction was decreased (27% vs.17%), and the jugular venous blood oxygen content was increased, and arterio-jugular difference of oxygen content, cerebral oxygen extraction ratio, and concentrations of serum S100β protein were decreased at T 2-4 in group N ( P<0.05). Conclusions:Nimodipine can improve the cognitive function after carotid endarterectomy, which may be related to the improvement in intraoperative cerebral oxygen metabolism and reduction of brain injury in elderly patients.

Objective:To evaluate the effect of low-dose esketamine on postoperative delirium (POD) in elderly frail patients undergoing laparoscopic radical resection of the gastrointestinal tumor.Methods:Ninety-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ frail patients of both sexes, aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2 and preoperative Fried frailty phenotype scale score≥3, scheduled for elective laparoscopic radical resection of the gastrointestinal tumor under general anesthesia, were divided into 2 groups ( n=47 each) using a random number table method: control group (group C) and low-dose esketamine group (group K). In group K, esketamine 0.5 mg/kg was given during induction of anesthesia, and esketamine 0.25 mg·kg -1·h -1 was continuously infused during operation until the end of operation.In group C, the equal volume of normal saline was given at the corresponding time point.After induction of anesthesia and before skin incision (T 1), at 1 day after operation (T 2) and at 3 days after operation (T 3), blood samples from the internal jugular vein were collected for determination of the concentrations of S100β protein and neuron-specific enolase (NSE) in serum by enzyme-linked immunosorbent assay.The intraoperative consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded.POD was evaluated by Confusion Assessment Method within 3 days after operation. Results:Compared with the baseline at T 1, the concentrations of serum S100β and NSE were significantly increased at T 2, 3 in both groups ( P<0.05). Compared with group C, the incidence of POD was significantly decreased (30% vs.13%), the intraoperative consumption of propofol and remifentanil was decreased, and concentrations of serum S100β protein and NSE were decreased at T 2, 3 in group K ( P<0.05). Conclusions:Low-dose esketamine can decrease the occurrence of POD in elderly frail patients undergoing laparoscopic radical resection of gastrointestinal tumor.