Granulation tissue hyperplasia after tracheotomy is a common clinical complication. Endoscopic treatment can temporarily relieve airway obstruction， however， it is associated with a high recurrence rate and poor long-term prognosis. Based on the traditional Chinese medicine （TCM） Kenang （窠囊） theory and combined with modern pathological mechanisms， this paper explores its correlation with the pathogenesis of post-tracheotomy granulation tissue hyperplasia. Drawing from clinical experience in applying the Kenang theory for treatment， this paper proposes that the fundamental pathogenesis of this condition lies in qi deficiency and organ dysfunction， while phlegm and blood stasis interlocking serve as the symptomatic manifestations. The treatment focuses on resolving phlegm and promoting blood circulation， dispersing nodules and eliminating stagnation， regulating qi flow， and reinforcing the body's vital energy while expelling pathogenic factors. This approach aims to dissolve phlegm and blood stasis， dissipate the Kenang， and ultimately prevent and treat granulation tissue hyperplasia.

ObjectiveTo investigate the incidence rate of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） in patients with difficult common bile duct intubation undergoing pancreatic duct stenting during surgery， as well as the effect of pancreatic duct stenting in the prevention and treatment of PEP， and to provide a basis for clinical treatment. MethodsA retrospective analysis was performed for the clinical data of 186 patients with biliary tract disease who underwent initial ERCP and had difficult common bile duct intubation in The First Affiliated Hospital of Zhengzhou University from January 2016 to December 2024， and according to the condition of pancreatic duct stenting， the patients were divided into control group with 73 patients （without pancreatic duct stenting）， 5Fr-5 cm stent group with 67 patients， and 7Fr-5 cm stent group with 46 patients. The three groups were compared in terms of baseline data， intraoperative procedures， and postoperative outcomes. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups； the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between multiple groups， and the Dunn method was used for further comparison between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Logistic regression analysis was used to investigate the influencing factors for PEP in patients with difficult intubation during ERCP. ResultsThe overall incidence rate of PEP was 12.37% （23/186）. Compared with the 5Fr-5 cm stent group and the 7Fr-5 cm stent group， the control group had a significantly higher incidence rate of PEP， a significantly higher score of postoperative abdominal pain， and a significantly longer length of postoperative hospital stay （all P0.01）， and 55.56% of the patients in the control group had moderate-to-severe PEP. The univariate Logistic regression analysis showed that intradiverticular papilla， double guide wire intubation， needle knife precut， the application of basket and balloon for removal of common bile duct stones， intraoperative biopsy， pancreatic duct stenting， intubation time≤10 minutes， frequency of intubation≤5 times， preoperative CRP≤5 mg/L were influencing factors for PEP （all P0.05）， and the multivariate Logistic regression analysis showed that intraoperative pancreatic duct stenting， needle knife precut， and intraoperative biopsy were independent influencing factors for the onset of PEP （all P0.05）. ConclusionPancreatic duct stenting during ERCP can effectively reduce the risk of PEP in patients with difficult intubation， while needle knife precut and intraoperative biopsy can increase the risk of PEP in patients with difficult intubation.

OBJECTIVES: To investigate pharmacologically active components of Yiqi Zishen Formula (YZF) and their mechanisms for alleviating airway inflammation in mice with chronic obstructive pulmonary disease (COPD). METHODS: Ultra-high-performance liquid chromatography coupled with quadrupole-orbitrap mass spectrometry was employed to characterize the chemical components in YZF and YZF-medicated rat serum. A compound-disease target network was constructed based on serum components of YZF to screen the key pathways and targets using enrichment analysis. A mouse model of cigarette smoke-induced COPD was used to evaluate the anti-inflammatory effect of YZF and validate the expression of key proteins in network pharmacology-enriched pathways. Fifty male C57BL/6J mice were randomized equally into control group, COPD model group, high- and low-dose YZF treatment groups, and N-acetylcysteine treatment group. Pulmonary function of the mice was assessed using whole-body plethysmography, and lung histopathology, alveolar structure, and airway remodeling were analyzed using HE staining. The levels of IL-1β, IL-6, and TNF‑α in bronchoalveolar lavage fluid (BALF) were determined with ELISA, and pulmonary expressions of PI3K, Akt, phosphorylated Akt (p-Akt), p65, and phosphorylated p65 (p-p65) were detected using immunohistochemistry. RESULTS: We identified a total of 156 chemical components (including 26 flavonoids or flavonoid glycosides, 27 alkaloids, and 11 saponins) in YZF and 43 prototype components in medicated rat serum. Network pharmacology revealed 704 YZF-related targets and 1199 COPD-associated targets. Integrated analysis suggested that the anti-COPD effects of YZF were associated with the PI3K-Akt signaling pathway. In mouse models of COPD, YZF treatment significantly increased mean alveolar number and peak expiratory flow (P<0.05), reduced mean linear intercept, bronchial wall thickness, lung coefficient, and BALF cytokine levels, and suppressed the expressions of PI3K, Akt, p-Akt, p65, and p-p65 in the lung tissues. CONCLUSIONS YZF alleviates COPD symptoms and airway inflammation in mice possibly by inhibiting the PI3K/Akt/NF‑κB pathway through its multiple components that interact with multiple targets.
Animals ; Pulmonary Disease, Chronic Obstructive/metabolism* ; Drugs, Chinese Herbal/therapeutic use* ; Signal Transduction/drug effects* ; Male ; Mice, Inbred C57BL ; Mice ; Proto-Oncogene Proteins c-akt/metabolism* ; Phosphatidylinositol 3-Kinases/metabolism* ; NF-kappa B/metabolism* ; Inflammation/drug therapy* ; Rats

Objective To compare the success rates of different culture methods for hemorrhagic amniotic fluid.Methods Thirty-one hemorrhagic amniotic fluid samples from pregnant women who were subjected to chromosomal examination at Anhui Maternal and Child Health Hospital were collected from January 2021 to December 2022.Two culture methods,the slide in situ culture box method(re-ferred to as the slide method)and the plastic bottle culture combined with slide in situ culture box method(referred to as the combined culture method),were used for cell cultivation.All the cells were harvested and stained with Giemsa staining,then the number of eligi-ble karyotype was counted and the success rates were compared between the two methods.Results Among the 31 cases of the slide method,21 were successfully cultured with a success rate of 67.7％.For the combined culture method,all the 31 cases were success-fully cultured with a success rate of 100％.The success rate of the combined culture method was significantly higher than that of the slide method(P＜0.05).Of 31 bloody amniotic fluid samples,three cases were fresh bleeding,and an average number of eligible kary-otype was 8 in the slide method and 32 in the combined culture method.Twenty-eight cases were old bleeding,and an average number of eligible karyotype was 13 in the slide method and 53 in the combined culture method.The number of eligible karyotype in the com-bined culture method was significantly higher than that of the slide method(P＜0.05).Conclusion The combined culture method is suitable for the cultivation of hemorrhagic amniotic fluid samples,and should be worthy of promotion in the clinics.

Community-acquired pneumonia （CAP） is a common respiratory infectious disease in the elderly， and traditional Chinese medicine （TCM） and integrated TCM and western medicine showed effectiveness. According to the clinical characteristics of CAP， the staging concepts of CAP infection and recovery are proposed， and the prevention and treatment goals and strategies of staging and grading are put forward in combination with the disease seve-rity of mild， moderate and severe infections. The main objectives are to increase the cure rate of mild and moderate pneumonia， to reduce the case fatality rate of severe pneumonia， and to reduce the incidence of new upper and lower respiratory tract infections during the recovery period， respectively. TCM prevention and treatment strategies： for mild pneumonia， treatments should scatter and dissipate external pathogens， diffuse and descend lung qi， dispel dampness and dissolve phlegm， or clear lung and dissolve phlegm； for moderate pneumonia， treatments should clear lungs and resolve toxins， dry dampness and dissolve phlegm， and supplementing with tonifying lungs and strengthen spleen， or benefit qi and nourish yin； for severe pneumonia， the treatment of dispelling pathogen and supporting healthy qi should be emphasised according to the primary and secondary levels of excess pathogen and deficiency healthy qi； and for the recovery period， treatments should mainly support healthy qi， and supplement with dispelling pathogen. Relevant clinical studies have been conducted for practical verification， and the results showed that integrated TCM and Western medicine treatment can improve the cure rate of mild to moderate pneumonia， decrease the case fatality rate of severe pneumonia， and reduce the re-hospitalisation of pneumonia during the recovery period， indicating that the staged and graded prevention and treatment strategy has important guiding value for improving the diagnosis and treatment of CAP.

ObjectiveTo evaluate the efficacy and safety of modified Qingjin Huatantang combined with Western medicine in the treatment of phlegm-heat and to provide reference for the clinical application of this therapy and development of new drugs. MethodChina Biology Medicine （CBM），Chinan National Knowledge Infrastructure （CNKI），Wanfang Data，VIP，and PubMed were searched for the randomized controlled trials （RCTs） of modified Qingjin Huatantang in the treatment of phlegm-heat that were published from inception to November 1，2023. Two researchers independently screened the RCTs and extracted data according to pre-set inclusion and exclusion criteria. The Cochrane Collaboration's tool for assessing risk of bias was used for quality evaluation. Revman 5.4 was used for the Meta-analysis of outcome indicators. ResultA total of 91 RCTs were included，involving 7 868 patients （3 942 patients in the experimental group and 3 926 patients in the control group）. The results of Meta-analysis showed that compared with simple Western medicine treatment，modified Qingjin Huatantang combined with Western medicine improved the clinical response rate ［relative risk （RR）=1.16，95% confidence interval （CI）［1.14，1.19］，P<0.000 01］ and PaO₂ ［mean difference （MD）=4.65，95%CI ［1.88，7.43］，P=0.001］. The combined therapy had advantages in decreasing the scores of clinical symptoms including cough ［MD=-0.69，95%CI ［-1.33，-0.06］，P=0.03），expectoration ［MD=-1.04，95%CI ［-2.02，-0.07］，P=0.04），phlegm volume ［MD=-0.38，95%CI ［-0.69，-0.07］，P=0.02］，fever ［MD=-0.22，95%CI ［-0.36，-0.09］，P=0.000 8］，wheezing ［MD=-0.34，95%CI ［-0.40，-0.29］，P<0.000 01］，chest tightness ［MD=-0.32，95%CI ［-0.39，-0.26］，P<0.000 01］，and rales ［MD=-0.35，95%CI ［-0.42，-0.27］，P<0.000 01］）. Moreover，the combined therapy outperformed Western medicine treatment alone in reducing PaCO₂ （MD=-5.42，95%CI ［-7.12，-3.72］，P<0.000 01］， white blood cell count （WBC） ［MD=-1.27，95%CI ［-1.56，-0.97］，P<0.000 01］，C-reactive protein （CRP） ［standard mean difference （SMD）=-1.52，95%CI ［-1.96，-1.07］，P<0.000 01］， procalcitonin （PCT） ［SMD=-1.23，95%CI ［-1.87，-0.58］，P=0.000 2］，and tumor necrosis factor （TNF）-α ［SMD=-2.63，95%CI ［-3.19，-2.08］，P<0.000 01］）， shortening hospital stay ［MD=-2.45，95%CI ［-3.34，-1.57］，P<0.000 01］， and lowering the incidence of adverse reactions ［RR=0.66，95%CI （0.49，0.88），P=0.005］. ConclusionModified Qingjin Huatantang combined with Western medicine in the treatment of patients with phlegm-heat syndrome has advantages in improving clinical response rate and PaO₂， reducing symptom scores and inflammatory factors， and shortening hospital stay， with high safety.

ObjectiveTo analyze the development status and quality of clinical practice guidelines for the treatment of dominant diseases with Chinese patent medicines （CPMs）. MethodsDatabases were searched from Jan. 2019 to Dec.2023 to collect the published clinical practice guidelines of CPMs for the treatment of dominant diseases. The information about the title， the participants， clinical problems， outcomes， evidence grade， recommendations， and recommendation strength in the included clinical practice guidelines were collected， for which the development status was analyzed， and the quality was evaluated with the Scientific， Transparent and Applicable Rankings （STAR） tool for clinical practice guidelines. ResultsTotally， 34 guidelines were included， involving 273 kinds of CPMs. One to ten （with the medium five） clinical problems were proposed from 29 clinical practice guidelines respectively. All the guidelines divided the evidence into four grades according to Grade of Recommendation Assessment， Deve-lopement an Evaluation. And 28 guidelines had five levels of recommendation strength. A total of 344 recommendations were extracted， including 86 strong-recommendations， 191 weak-recommendations （including 36 weak recommendations only based on expert consensus） and 67 recommendations with unclear recommendation strength. All guidelines had high scores in the three areas of “clinical questions （94.20%）”， “evidence （91.45%）” and “recommendations （89.06%）”， while the scores in the three areas of “registry （22.06%）”， “protocol （19.00%）” and “accessibility （31.51%）” were low. The STAR recommended stars of 8 guidelines were 5.0~4.0 stars， while that of 18 guidelines were 3.5~2.5 stars， and 8 guidelines were 2.0~1.0 stars. The three guidelines with the highest recommended stars were depressive disorder， community-acquired pneumonia， and influenza in adult. ConclusionThere is a certain gap in the quality of the published clinical practice guidelines of CPMs， and the quality of the guidelines could be further improved in registry， protocols， funds， and accessibility.

【Objective】 To explore the feasibility of en-bloc resection of bladder tumors by flexible cystoscope combined with laparoscopic instruments through urethra and to provide reference for the clinical application of this technique. 【Methods】 Self-designed and processed transurethral single-hole PORT and Olympus electronic cystoscope were used as observation mirror; Φ1.8 mm soft grasper, tissue scissors, electric hook, and ultrasonic scalpel were used as instruments; the porcine bladder was used as a model.The PORT was placed through the urethra, and the cystoscope was inserted to observe the inner wall of the bladder and the condition of the mucosa.After the lesion site was identified in the bladder cavity, the soft grasper was inserted to pull the mucosa to be removed, which was then fixed with tension at the target position to maintain a satisfactory feild of view.The surgeon held the cystoscope in the left hand, and operated the laparoscopic instruments into the bladder cavity through the PORT with the right hand.Observing with the cystoscope and lifting and pulling the mucosa with the grasper, the surgeon simulated the cutting and pushing actions to realize the en-bloc resection of the lesioned mucosa. 【Results】 The mucosa at 4 different locations were successfully resected on 2 in vitro porcine bladder models. 【Conclusion】 The in vitro experiments show that the combination of flexible electronic cystoscope and laparoscopic instruments achieves synergistic effects in en-bloc resection of bladder tumor by transurethral single-hole laparoscope without additional iatrogenic bladder injury caused by percutaneous bladder incision.This method is feasible in the treatment of bladder tumors, and has the potential of clinical application after further optimization.

Chronic obstructive pulmonary disease(COPD)poses a serious threat to human health and carries a heavy burden of disease.The disease burden mainly includes traditional epidemiological indicators such as morbidity,disability rate,and mortality rate,as well as economic burden evaluation indicators such as direct economic burden,indirect economic burden,and intangible economic burden,as well as social/health burden evaluation indicators such as potential years of life reduction,disability adjusted life years,and quality adjusted life years.It summarized the existing methods for evaluating the burden of COPD diseases and proposed the following suggestions:(1)enriching economic burden research methods to comprehensively and accurately evaluate direct economic burden;(2)expanding the scope of economic burden research and improve the economic burden research of COPD;(3)strengthening information management and enhance the accuracy of disease burden data;(4)exploring multidimensional indicators and establish a COPD disease burden evaluation system;(5)strengthening relevant research and highlight the health economics advantages of traditional Chinese medicine intervention in COPD.It can provide references for establishing a COPD disease burden evaluation system and policy formulation.