ObjectiveThis paper aims to investigate and evaluate the staged efficacy and safety of the representative empirical prescription of the “Zhu Ke Jiao” theory， Qijia Rougan prescription， combined with entecavir in the treatment of hepatic fibrosis in chronic hepatitis B. MethodsA multicenter randomized controlled clinical study was conducted， and 101 patients diagnosed with chronic hepatitis B-related hepatic fibrosis （CHB-HF） who met the diagnosis and inclusion criteria were randomly assigned to an observation group （Qijia Rougan prescription + entecavir） and a control group （entecavir）. The treatment duration was 24 weeks. Liver stiffness measurement （LSM）， fibrosis-4 index （FIB-4）， portal vein diameter， hepatitis B serology， biochemical indicators， hepatic fibrosis markers in serum ［hyaluronic acid （HA）， laminin （LN）， procollagen Ⅲ peptide （PⅢP）， and type Ⅳ collagen （Ⅳ-C）］， and traditional Chinese medicine syndrome scores were used as efficacy evaluation indicators. Efficacy assessments and explorations of different staged subgroups of Qijia Rougan prescription were conducted according to LSM values based on the Metavir pathological staging standard. ResultsA total of 98 cases were included for statistical analysis， with 49 cases in the observation group and 49 in the control group. The general data of the patients in both groups were comparable. Compared with the same group before treatment， the observation group showed a significant reduction in LSM and FIB-4 （P<0.01）， as well as notable improvements in LN， Ⅳ-C， and various TCM syndrome scores （P<0.05， P<0.01）. When compared to the control group after treatment， the observation group demonstrated significant improvements in LSM， FIB-4， and various TCM syndrome score indicators （P<0.05， P<0.01）， indicating that the observation group performed better than the control group. Subgroup analysis of the regression of hepatic fibrosis stages showed that compared to the same group before treatment， the observation group had better improvement in regression of stages F2 and F3 （P<0.05）. When compared to the control group after treatment， the observation group exhibited superior improvement in regression of stage F3 （P<0.05）. No adverse events occurred in either group during the treatment period. ConclusionCompared with entecavir alone， the combination of Qijia Rougan prescription and entecavir significantly improves the degree of hepatic fibrosis and clinical TCM symptoms in patients. The optimal intervention period is primarily during stage F3， which is a potential “interception” point of the “Zhu Ke Jiao” theory.

Various degrees of post-infection symptoms after novel coronavirus infection are called long COVID or post COVID-19 syndrome.Some of the patients with long COVID syndrome exhibit the symptoms of spontaneous sweating,fatigue and weakness,palpitation and shortness of breath.Following the theory of six-meridian syndrome differentiation and the clinical principle of prescriptions corresponding to syndromes,Professor Li Saimei differentiated the spontaneous sweating of patients with long COVID into four main types,namely spontaneous sweating due to disharmony between taiyang nutritive qi and defensive qi,spontaneous sweating due to Yangming damp-heat,spontaneous sweating due to taiyin cold-damp,and spontaneous sweating due to jueyin blood deficiency,which can be treated with Guizhi Decoction,Gegen Qinlian Decoction,Fuzi Lizhong Decoction,and Danggui Sini Decoction plus Erzhi Pills,respectively.In the view of Professor Li Saimei,spontaneous sweating in patients with long COVID may result from disharmony between nutritive qi and defensive qi,or from damp-heat pathogen,or from cold-damp pathogen,or from deficiency of qi and blood.Therefore,the therapies for spontaneous sweating should be focused on harmonizing nutritive qi and defensive qi,drying dampness and eliminating pathogens,warming meridians and nourishing blood.Moreover,protecting the heart-yin and heart-yang should be taken into account,and herbal medicines with the actions of activating heart-yang and replenishing heart-yin and herbs for tranquilizing and alleviating palpitation can be selected in clinic.

BACKGROUND:With the progress of minimally invasive procedures of the spine,endoscopic lumbar decompression has been widely used in the treatment of lumbar disc herniation.The indications of different endoscopic surgical approaches are different,and the decision of the specific operation plan needs to be combined with the actual situation and the choice of clinical surgeons. OBJECTIVE:To investigate the short-term effect in treatment of single-level lumbar disc herniation by percutaneous endoscopic visual trephine arthroplasty. METHODS:Ninety patients with single-level lumbar disc herniation admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021 who met the inclusion criteria were included in this study.According to different approaches of percutaneous endoscopic visual trephine arthroplasty,they were divided into transforaminal approach group(control group,n=48 cases)and translaminar approach group(trial group,n=42 cases).The general information of patients in the two groups was recorded,including sex,age,disease course,body mass index,incision length,operation time,intraoperative fluoroscopy times,length of hospital stay,and amount of blood loss.Visual analog scale score of pain and Japanese Orthopaedic Association score at different follow-up stages were assessed.The modified MacNab standard was used to evaluate the clinical outcome at the last follow-up,and the postoperative complications and recurrence rate were measured. RESULTS AND CONCLUSION:(1)The operation time and intraoperative fluoroscopy times of the trial group were less than those of the control group,and the difference was statistically significant(P<0.05).However,there were no significant differences in intraoperative blood loss,incision length,and hospital stay between the two groups(P>0.05).(2)There was no significant difference in visual analog scale score of pain and Japanese Orthopaedic Association score between the two groups before surgery(P>0.05).However,visual analog scale of pain and Japanese Orthopaedic Association score were significantly improved 1 week,3,6,and 12 months after surgery(P<0.05).(3)At the last follow-up,the good and good rate of modified MacNab standard was 94%in the control group and 95%in the trial group.(4)In the control group,one patient still felt back and leg pain after surgery,underwent open surgery,and recovered well after surgery without obvious sequelae.There were no postoperative complications or recurrent cases in the trial group.(5)It is concluded that both percutaneous transforaminal approach and interlaminar approach have good short-term clinical efficacy and high patient satisfaction in the treatment of single-level lumbar disc herniation,but the time of the interlaminar approach is shorter and has less intraoperative fluoroscopy times.

Objective:To analyze the research literature related to end tuberculosis (TB) using bibliometric methods, so as to provide researchers with insights into current research trends and hotspots in this field.Methods:A search was conducted using the Web of Science core collection data base on March 5, 2024. The research was limited to articles and reviews published between 2014 and 2023. The results were visualized with VOSviewer, and an analysis was performed on the involved national, international research cooperation networks and keyword clustering.Results:A total of 1 092 articles related to end TB research were retrieved and screened, with a total citation counts of 14 871 and an average citation counts of 13.62 per article. The United States of America had the highest number of publications (328 articles, 30.04%), while China ranked seventh (100 articles, 9.16%). International scientific collaboration network analysis indicated that countries primarily included the United Kindom, the United States of America, Switzerland, South Africa, the Netherlands, Australia, and India, which had formed close cooperation in the field of end TB research. Keyword clustering analysis suggested that current research hotspots in end TB field included cost analysis related to TB, management of latent TB individuals, strategies for TB prevention and control, key technologies in TB elimination, and TB epidemiology and associated risk factors.Conclusions:Over the past decade, the number of publications and citations in the field of end TB is relatively high. International research collaboration has been extensive, and the research content covers multiple dimensions, including the management and cost analysis of different disease stages, technological innovations, considerations for comprehensive control strategy, and epidemiology.

ObjectiveTo explore the efficacy and predictive indicators of stellate ganglion block （SGB） as an adjunctive intervention for chronic subjective tinnitus and accumulate experience for the application of SGB in the clinical treatment of tinnitus. MethodsA retrospective review was conducted on the data of chronic subjective tinnitus patients who received SGB intervention， with unsatisfactory outcomes otherwise. Pure tone audiometry （PTA）， tinnitus loudness evaluation and Pittsburgh sleep quality index （PSQI） were used. The tinnitus handicap inventory （THI） scores were compared before and after SGB intervention. Correlation analysis and linear regression equations were employed to identify the potential indicators predicting the effectiveness of SGB intervention. Statistical analysis was performed by SPSS 24.0 software. ResultsBy April 2023， a total of 107 patients with chronic subjective tinnitus had undergone SGB intervention， including 67 male and 40 female， with a mean age of （45.32±11.40） years old and an average tinnitus history of （20.32±24.64） months ［16 （12~20）］. Only 7 patients （6.54%） quitted the intervention for personal reasons， which demonstrated good compliance with the intervention. No patients experienced adverse reactions such as infection at the injection site， hematoma， nerve injury， local anesthetic intoxication and so on， which revealed good safety. After SGB intervention， THI scores decreased to below 36 points in 77 patients and decrease by 10 points or more in 12 of the remaining patients， with a total effective rate of 89%. A paired sample t-test showed a significant difference in THI scores before and after SGB intervention （t=15.575， P<0.001）， indicating good improvement. Pearson correlation analysis suggested that pre-intervention THI scores and subjective tinnitus loudness were significantly positively correlated with the improvement level of THI scores （P<0.05）. Further stepwise linear regression analysis found that "pre-intervention THI scores" had statistical significance （P<0.001）， with a regression coefficient of 0.308， predicting a 17.4% improvement level in THI scores. ConclusionsDue to its good and safe short-term effects， SGB intervention can be used as a supplementary option for chronic subjective tinnitus when other interventions are not ideal， especially for patients with higher THI scores. However， further research is needed to clarify the long-term efficacy and underlying mechanisms， in order to establish a more solid theoretical basis for SGB intervention in the treatment of subjective tinnitus.

OBJECTIVE To evaluate the cost-effectiveness of the first-line treatment using the combination therapy of sugemalimab and chemotherapy （hereinafter referred to as the “combination therapy”） for advanced esophageal squamous cell carcinoma （ESCC） with high programmed death-ligand 1 （PD-L1） expression from the perspective of the Chinese healthcare system. METHODS A partitioned survival model was constructed based on data from the GEMSTONE-304 study. The model cycle was set at 3 weeks， with a study duration of 10 years and a discount rate of 5%. The primary output parameters of the model included total costs， quality-adjusted life year （QALY）， incremental costs， and incremental cost-effectiveness ratio （ICER）. Cost- utility analysis was employed to assess the economic feasibility of the combination therapy compared to chemotherapy alone. The robustness of the base case analysis results was evaluated through univariate sensitivity analysis， probabilistic sensitivity analysis， and scenario analysis. RESULTS The ICER of the combination therapy compared to chemotherapy alone was 288 430.35 yuan/QALY， significantly exceeding the willingness-to-pay （WTP） threshold of 173 354.52 yuan/QALY which was set at 1.94 times the per capita gross domestic product （GDP） in 2023. The price of sugemalimab was the primary factor influencing the ICER. When the WTP threshold was set at 1.94 times the per capita GDP （173 354.52 yuan/QALY）， the probability of the combination therapy being cost-effective compared to chemotherapy alone was 0. The combination therapy only became cost-effective compared to chemotherapy alone when the price of the drug dropped to 6 107.41 yuan per box （600 mg）. CONCLUSIONS From the perspective of the Chinese healthcare system， the combination therapy for first-line treatment of advanced ESCC with high PD-L1 expression is not cost-effective； the combination therapy is cost-effective when the price of sugemalimab decreas by 50.65%.

Objective:To evaluate the performance of rural practitioners of endoscopic cleaning and disinfection participating in the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers and to analyze the influencing factors.Methods:The questionnaires for skill assessment were designed based on the skill scheme and clinical practice of the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China, and the App Early diagnosis, Early treatment was used as the examination platform. The practitioners in 539 county hospitals from 25 provinces participating in the program in 2019 were assessed for techniques and skills for endoscopic cleaning and disinfection and the excellence rate was calculated. Multivariate logistic regression model was used to analyze the influencing factors for the examination. Results:A total of 1 671 endoscopic cleaning and disinfection practitioners participated in the assessment with the score of 73.41±16.60. The passing rate was 85.82%, and the excellence rate was 44.94%. Among all questions, the correct rate of "opportunistic screening flow chart" was the highest (98.21%), and that of "the evaluation index for mass screening" was the lowest (57.89%). The multivariate logistic regression analysis showed that the excellence rate was high in practitioners who had a bachelor degree or above ( OR=1.627,95% CI:1.319-2.007, P<0.001), the career for 5 to <15 years (5 to <10 years: OR=1.329,95% CI:1.045-1.689, P=0.020; 10 to <15 years: OR=1.384,95% CI:1.026-1.867, P=0.033), working in eastern and central regions (eastern regions: OR=3.476,95% CI:2.368-5.103, P<0.001;central regions: OR=4.028,95% CI:2.679-6.057, P<0.001) and with full understanding of the screening scheme ( OR=1.547,95% CI:1.246-1.921, P<0.001) . Conclusion:Practitioners on the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China have mastered the basic screening scheme and skills for endoscopic cleaning and disinfection. The education background, duration of the career, area and understanding of screening scheme are influencing factors for the excellence rate of endoscopic cleaning and disinfection.

Objective:To clarify the clinical significance, diagnostic and prognostic values of circular RNA circ_0141633 and circ_0008234 in peripheral blood of pancreatic cancer, and analyze their impact on the biological function of pancreatic cancer cells.Methods:The peripheral blood samples of 97 pancreatic cancer patients and 71 healthy controls were collected, and the expression of circ_0141633 and circ_0008234 was analyzed by real-time quantitative polymerase chain reaction (qRT-PCR). The relationships between the expression of circ_0141633 and circ_0008234 and clinicopathological characteristics and prognosis of pancreatic cancer were analyzed by chi-square test, K-M survival curves and Cox proportional hazards regression model. The area under curve (AUC), sensitivity and specificity of circ_0141633 and circ_0008234 in the diagnosis of pancreatic cancer were analyzed by receiver operating characteristic (ROC) curve. The effects of circ_0141633 and circ_0008234 on the proliferation, migration, invasion and epithelial mesenchymal transformation (EMT) of Bxpc-3 cells were analyzed by methyl thiazolyl tetrazolium (MTT) method, cell scratch test, Transwell invasion and Western blot.Results:The expression of circ_0141633 and circ_0008234 in peripheral blood of pancreatic cancer patients was higher than those of healthy controls (all P<0.05). High expression of circ_0141633 and circ_0008234 was associated with higher clinical stage, lymph node metastasis and venous invasion, and were independent risk factors for poor prognosis in pancreatic cancer (all P<0.05). The overall survival rate of patients with high expression of circ_0141633 and circ_0008234 was significantly lower than that of patients with low expression of circ_0141633 and circ_0008234 (all P<0.05). The AUC of circ_0141633, circ_0008234, the combination of circ_0141633 and circ_0008234, CA19-9 in the diagnosis of pancreatic cancer was 0.70, 0.67, 0.88 and 0.82, with sensitivity of 64.32%, 60.79%, 78.22% and 73.97%, respectively. The specificity was 68.54%, 65.46%, 81.65% and 79.41%, respectively. The diagnostic efficiency of combination was superior to CA19-9, circ_0141633 and circ_0008234 alone (all P<0.05). Interfering with circ_0141633 and circ_0008234 alone could inhibit the proliferation, migration, invasion and EMT of Bxpc-3 cells, and the above inhibitory effect was more obvious after interfering with both of circ_0141633 and circ_0008234 (all P<0.05). Conclusions:The high expression of circ_0141633 and circ_0008234 in peripheral blood could be used as potential diagnostic and prognostic biomarkers of pancreatic cancer, and could promote the progression of pancreatic cancer.

Objective:To systematically quantify the access to screening and surveillance service of liver cancer in populations in China, especially a series of sub-indicators of the availability.Methods:Following the specific indicators applied by the International Agency for Research on Cancer in the session of availability and use of screening practices in several cancer screening handbooks, information about the access/availability of liver cancer screening and surveillance in population in China were collected; the indicators included local policies and guidelines, procedures most commonly used or recommended, population coverage and participation rate, compliance and related factors, treatment rate, acceptability, equity and others. Systematic review approach was used, combined with searching core literatures/monograph, websites of governments and available program reports, for a systematic analysis on the access to liver cancer screening and surveillance in populations in China.Results:A total of 34 journal articles were included from the systematic review and most of which were about the participation of secondary liver screening or surveillance compliance; additional information were mainly obtained from the other sources. Overall, there were clearly recommended screening and surveillance procedures for liver cancer in the three major cancer screening programs funded by the central government of China. It was estimated that 0.09% of the population aged 35-74 years were covered by liver cancer screening in 2019 in China. The overall participation rates of secondary screening ranged from 37.5% to 62.3% in three major programs, the median compliance rate of surveillance was reported as 26.9% ( Q1, Q3: 23.5%, 41.0%) in the 6 included studies. Two studies reported the factors affecting the participation and compliance. A large-scale multicenter analysis showed that the subject acceptability to alpha fetoprotein test combined with ultrasound screening was as high as 99.3% in high-risk population in urban area. The treatment rate of liver cancer founded by screening, surveillance or follow-up was estimated to be >90% in rural population. No studies of equity were obtained via the systematic review. Conclusions:The public health service programs in China all recommend specific procedures for liver cancer screening in general population and surveillance for high-risk individuals. However, the overall availability needs to be improved, particularly in the indicator of population coverage. Participation rates of screening and compliance rates of surveillance varied among the included programs and the studies, suggesting that the influencing factors need to be further identified. The relatively high subject acceptability suggests the potential demands for screening service. More efforts are needed to address the access to screening and surveillance of liver cancer in populations in China.

Objective:To investigate the 30-day mortality risk in elderly patients with sepsis-induced myocardial dysfunction(SIMD), and to analyze its related risk factors.Methods:This was a multicenter retrospective case-control study.A total of 254 elderly patients with sepsis or septic shock admitted to the Second Hospital of Shanxi Medical University(117 cases), the First Hospital of Shanxi Medical University(89 cases)and Shanxi Provincial People's University(48 cases)from January 2015 to December 2019 were enrolled.According to whether or not combined with SIMD, patients were divided into the SIMD group(n=68)and the control group(n=186). All patients were followed for 30 day to evaluate the rate of mortality and the related factors.Results:Among 254 elderly patients, the incidence of SIMD was 26.8%.There were significant differences between the SIMD group and the control group in age, heart rate, E/A value, left ventricular ejection fraction(LVEF), procalcitonin, lactate, C-reactive protein, troponin, N-terminal pro-B-type natriuretic peptide(NT-proBNP)and sequential organ failure assessment(SOFA)score(all P<0.05). The significant differences were found between the SIMD group and the control group in the all-cause mortality risk, the duration of invasive mechanical ventilation, ICU hospitalization time and total hospitalization days(35.3% or 24 cases vs.22.6% or 42 cases, 7.0 d vs.4.8 d, 9.5 d vs.7.5 d and 18.8 d vs.15.1 d, P<0.05). Age ≥65 years( RR=1.867), diabetes( RR=2.661), procalcitonin ≥13.2 μg/L( RR=3.307), and lactate ≥3.65 mmol/L( RR=2.964)were risk factors for SIMD, and serum troponin ≥0.08 μg/L( HR=2.019), NT-proBNP ≥537.4 ng/L( HR=4.411), lactate ≥3.65 mmol/L( HR=3.934)and LVEF <50.0%( HR=3.761)were risk factors for the mortality(all P<0.05). Conclusions:Elderly patients with the sepsis-induced SIMD have severe infections, mainly involving the left ventricle, and have an increased risk of mortality and a longer duration of hospital stays.