ObjectiveThis paper aims to verify the therapeutic effect of Cranial Painkiller pills' extract powder prepared by the new process on the rat's trigeminal neuralgia model caused by infraorbital injection of Talci Pulvis， evaluate its potential clinical application value， and compare the therapeutic effect with that of Cranial Painkiller granules， so as to provide data support for the application of the Cranial Painkiller pills' extract powder and precise treatment. MethodsThe rat's trigeminal neuralgia model was constructed by infraorbital injection of Talci Pulvis， and the rats were randomly divided into the normal group， model group， carbamazepine group （60 mg·kg^-1）， Cranial Painkiller granules group （2.70 g·kg^-1）， and low， medium， and high dosage groups of Cranial Painkiller pills' extract powder （1.35， 2.70， 5.40 g·kg^-1） according to the basal mechanical pain thresholds， and there were 10 rats in each group. The drug was administered by gavage to each group 2 h after modeling， and distilled water was given by gavage to the normal and model groups under the same conditions once a day for 10 d. Von Frey brushes were used to measure mechanical pain thresholds in rats. Hematoxylin-eosin （HE） staining was used to detect pathological changes in the trigeminal ganglion， and enzyme-linked immunosorbent assay （ELISA） was used to detect the inflammatory factors interleukin-1 （IL-1）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， and tumor necrosis factor-α （TNF-α） levels in rat serum， as well as neuropeptide substance P （SP） and β-endorphin （β-EP） levels in rat brain tissue. Western blot technique was used to detect the levels of NLRP3， ASC， Caspase-1， and OTULIN proteins in rat brain tissue. ResultsCompared with the normal group， the pain threshold of rats in the model group showed a continuous significant decrease （P<0.01）. The pathological damage of brain tissue was significant （P<0.01）， and the inflammatory levels of IL-1， IL-6， IL-8， and TNF-α in serum were significantly elevated （P<0.01）. The level of the SP in the brain tissue was significantly elevated （P<0.01）， and the level of β-EP was significantly reduced （P<0.01）， while the level of OTULIN was significantly reduced， and NLRP3， ASC， and Caspase-1 protein levels were significantly elevated （P<0.01）. After administration of the drug， compared with the model group， the pain threshold of each dose group of the Cranial Painkiller pills' extract powder and the Cranial Painkiller granules group significantly increased （P<0.01）. The inflammatory levels of IL-1， IL-6， IL-8， and TNF-α and SP levels significantly decreased （P<0.01）， and the β-EP levels were significantly elevated （P<0.01）， while the levels of OTULIN protein were significantly elevated （P<0.05， P<0.01）， and the levels of NLRP3， ASC proteins were decreased （P<0.01）in high dose Cranial Painkiller pills' extract powder. Meanwhile， compared with those in the model group， the trigeminal ganglion lesions of rats in the Cranial Painkiller pills' extract powder and Cranial Painkiller granules groups showed different degrees of improvement （P<0.05， P<0.01）. ConclusionThe Cranial Painkiller pills' extract powder has significant therapeutic effects on the rat model of trigeminal neuralgia induced by infraorbital injection of Talci Pulvis， and its mechanism is related to the improvement of OTULIN-regulated neuroinflammation.

ObjectiveThis paper aims to verify the therapeutic effect of Cranial Painkiller pills' extract powder prepared by the new process on the rat's trigeminal neuralgia model caused by infraorbital injection of Talci Pulvis， evaluate its potential clinical application value， and compare the therapeutic effect with that of Cranial Painkiller granules， so as to provide data support for the application of the Cranial Painkiller pills' extract powder and precise treatment. MethodsThe rat's trigeminal neuralgia model was constructed by infraorbital injection of Talci Pulvis， and the rats were randomly divided into the normal group， model group， carbamazepine group （60 mg·kg^-1）， Cranial Painkiller granules group （2.70 g·kg^-1）， and low， medium， and high dosage groups of Cranial Painkiller pills' extract powder （1.35， 2.70， 5.40 g·kg^-1） according to the basal mechanical pain thresholds， and there were 10 rats in each group. The drug was administered by gavage to each group 2 h after modeling， and distilled water was given by gavage to the normal and model groups under the same conditions once a day for 10 d. Von Frey brushes were used to measure mechanical pain thresholds in rats. Hematoxylin-eosin （HE） staining was used to detect pathological changes in the trigeminal ganglion， and enzyme-linked immunosorbent assay （ELISA） was used to detect the inflammatory factors interleukin-1 （IL-1）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， and tumor necrosis factor-α （TNF-α） levels in rat serum， as well as neuropeptide substance P （SP） and β-endorphin （β-EP） levels in rat brain tissue. Western blot technique was used to detect the levels of NLRP3， ASC， Caspase-1， and OTULIN proteins in rat brain tissue. ResultsCompared with the normal group， the pain threshold of rats in the model group showed a continuous significant decrease （P<0.01）. The pathological damage of brain tissue was significant （P<0.01）， and the inflammatory levels of IL-1， IL-6， IL-8， and TNF-α in serum were significantly elevated （P<0.01）. The level of the SP in the brain tissue was significantly elevated （P<0.01）， and the level of β-EP was significantly reduced （P<0.01）， while the level of OTULIN was significantly reduced， and NLRP3， ASC， and Caspase-1 protein levels were significantly elevated （P<0.01）. After administration of the drug， compared with the model group， the pain threshold of each dose group of the Cranial Painkiller pills' extract powder and the Cranial Painkiller granules group significantly increased （P<0.01）. The inflammatory levels of IL-1， IL-6， IL-8， and TNF-α and SP levels significantly decreased （P<0.01）， and the β-EP levels were significantly elevated （P<0.01）， while the levels of OTULIN protein were significantly elevated （P<0.05， P<0.01）， and the levels of NLRP3， ASC proteins were decreased （P<0.01）in high dose Cranial Painkiller pills' extract powder. Meanwhile， compared with those in the model group， the trigeminal ganglion lesions of rats in the Cranial Painkiller pills' extract powder and Cranial Painkiller granules groups showed different degrees of improvement （P<0.05， P<0.01）. ConclusionThe Cranial Painkiller pills' extract powder has significant therapeutic effects on the rat model of trigeminal neuralgia induced by infraorbital injection of Talci Pulvis， and its mechanism is related to the improvement of OTULIN-regulated neuroinflammation.

Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Objective To explore the influencing factors of poor prognosis after successful recanalization of symptomatic acute internal carotid artery occlusion(AICAO)by applying endovascular therapy(EVT)technology.Methods We made a retrospective analysis of the clinical and imaging data of 62 symptomatic AICAO patients.After collateral evaluation and recanalization therapy,we obtained flat CT and DSA images,together with the findings of the collateral circulation assessment.At 24.0±6.0 hours after surgery,head plain CT scans were reexamined,and at 14 days after surgery or at discharge,neurological function was assessed using the NIHSS scale.Using the modified Rankin scale,we assessed neurological function and prognosis over a 90-day period.Results Each of the 62 patients had a TICI grade of 2b or 3 and was successfully recanalized.On average,it took 124.36±66.31 minutes from puncture to recanalization.Two instances involved iatrogenic dissection,while twelve cases had intraoperative distal thrombus escape episodes.Of all the patients,32 ones(51.6％)had a fair prognosis,whereas 30 patients(48.4％)had a bad prognosis.The two patient groups differed significantly in the ASPECT score,preoperative NIHSS score,intraoperative balloon catheter usage,postoperative 24 hour and 14 days NIHSS score,postoperative 14 days neurological function,and all-cause mortality within 90 days(all P＜0.05).The best intervention threshold for preoperative NIHSS score was 11.5 points,and both the preoperative NIHSS score and intraoperative BGC utilization were independent predictors influencing poor outcome.Conclusion The preoperative NIHSS score and intraoperative BGC usage are independent predictors of 90-day poor prognosis in AICAO patients with symptomatic AICAO who underwent successful recanalization via endovascular therapy.

Objective:To investigate a surgical method and clinical outcomes of a fascia pedicled island flap with dorsal branch of proper palmar digital nerve in reconstruction of defects of digital pulp.Methods:Seventy-five patients who had digital pulp defects and treated at Department of Orthopaedics, Xinjiang Production and Construction Corps Alar Hospital, Shaw Hospital Affiliated Zhejiang University School of Medicine, from December 2019 to December 2022, were retrospectively analysed. The patients were 40 males and 35 females aged 25-61 years with an average age of 42 years. The defects of digital pulp involved in 23 thumbs, 15 per group of index fingers, middle fingers and ring fingers, and 7 little fingers. The digital pulp defects were 0.8 cm×0.9 cm to 1.5 cm×2.1 cm in size, and the sizes of flap were 1.0 cm×1.2 cm to 1.8 cm×2.4 cm. Donor sites were covered by medium-thickness skin grafts and pressurised bandage was applied. Clinical outcomes of the surgery were monitored through the postoperative follow-ups at outpatient clinic, WeChat and telephone reviews.Results:Postoperative follow-up ranged 9 to 15 months, with an average of 12 months. The donor sites and skin grafts all achieved stage-I healing. Seventy-three flaps completely survived after surgery. However, 2 flaps had partial necrosis, which healed after dressing changes, 4 flaps encountered flap bruising and swelling, which were rectified by removal of high-tension sutures, and 7 flaps had tension blisters, which had disappeared in 2 weeks. At the final follow-up, the appearance and texture of the flaps were graded as excellent for 54 flaps and good for 21 flaps, all without pale, cyanotic or dark in colour. Forty-nine flaps showed normal elasticity or with slight atrophy, 24 with mild atrophy, 2 with moderate atrophy and none with obvious or severe atrophy. Mobility of the affected digits was rated as excellent for 57 digits (average 42.3°), good for 12 (average 26.7°) and fair in 6 digits (average 16.3°). TPD of flap surfaces ranged 6 to 11 mm, with an average of 8.1 mm. Digital function were evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with 48 digits in excellent (average 11.2 points), 22 in good (average 8.1 points) and 5 in fair (average 5.4 points) and with a combined excellence and good rates of 93.33%. All flap donor sites were in normal function. For patient satisfaction: 53 patients were well satisfied, 21 were fairly satisfied and 1 was dissatisfied.Conclusion:Application of the island flap with dorsal branch of proper palmar digital nerve with fascio-pedicled in reconstruction of the defect of digital pulp has a high survival rate, simple surgical operation, good satisfactory outcome, with the digital artery being remained intact.

Objective To explore the influencing factors of poor prognosis after successful recanalization of symptomatic acute internal carotid artery occlusion(AICAO)by applying endovascular therapy(EVT)technology.Methods We made a retrospective analysis of the clinical and imaging data of 62 symptomatic AICAO patients.After collateral evaluation and recanalization therapy,we obtained flat CT and DSA images,together with the findings of the collateral circulation assessment.At 24.0±6.0 hours after surgery,head plain CT scans were reexamined,and at 14 days after surgery or at discharge,neurological function was assessed using the NIHSS scale.Using the modified Rankin scale,we assessed neurological function and prognosis over a 90-day period.Results Each of the 62 patients had a TICI grade of 2b or 3 and was successfully recanalized.On average,it took 124.36±66.31 minutes from puncture to recanalization.Two instances involved iatrogenic dissection,while twelve cases had intraoperative distal thrombus escape episodes.Of all the patients,32 ones(51.6％)had a fair prognosis,whereas 30 patients(48.4％)had a bad prognosis.The two patient groups differed significantly in the ASPECT score,preoperative NIHSS score,intraoperative balloon catheter usage,postoperative 24 hour and 14 days NIHSS score,postoperative 14 days neurological function,and all-cause mortality within 90 days(all P＜0.05).The best intervention threshold for preoperative NIHSS score was 11.5 points,and both the preoperative NIHSS score and intraoperative BGC utilization were independent predictors influencing poor outcome.Conclusion The preoperative NIHSS score and intraoperative BGC usage are independent predictors of 90-day poor prognosis in AICAO patients with symptomatic AICAO who underwent successful recanalization via endovascular therapy.

Objective:To investigate a surgical method and clinical outcomes of a fascia pedicled island flap with dorsal branch of proper palmar digital nerve in reconstruction of defects of digital pulp.Methods:Seventy-five patients who had digital pulp defects and treated at Department of Orthopaedics, Xinjiang Production and Construction Corps Alar Hospital, Shaw Hospital Affiliated Zhejiang University School of Medicine, from December 2019 to December 2022, were retrospectively analysed. The patients were 40 males and 35 females aged 25-61 years with an average age of 42 years. The defects of digital pulp involved in 23 thumbs, 15 per group of index fingers, middle fingers and ring fingers, and 7 little fingers. The digital pulp defects were 0.8 cm×0.9 cm to 1.5 cm×2.1 cm in size, and the sizes of flap were 1.0 cm×1.2 cm to 1.8 cm×2.4 cm. Donor sites were covered by medium-thickness skin grafts and pressurised bandage was applied. Clinical outcomes of the surgery were monitored through the postoperative follow-ups at outpatient clinic, WeChat and telephone reviews.Results:Postoperative follow-up ranged 9 to 15 months, with an average of 12 months. The donor sites and skin grafts all achieved stage-I healing. Seventy-three flaps completely survived after surgery. However, 2 flaps had partial necrosis, which healed after dressing changes, 4 flaps encountered flap bruising and swelling, which were rectified by removal of high-tension sutures, and 7 flaps had tension blisters, which had disappeared in 2 weeks. At the final follow-up, the appearance and texture of the flaps were graded as excellent for 54 flaps and good for 21 flaps, all without pale, cyanotic or dark in colour. Forty-nine flaps showed normal elasticity or with slight atrophy, 24 with mild atrophy, 2 with moderate atrophy and none with obvious or severe atrophy. Mobility of the affected digits was rated as excellent for 57 digits (average 42.3°), good for 12 (average 26.7°) and fair in 6 digits (average 16.3°). TPD of flap surfaces ranged 6 to 11 mm, with an average of 8.1 mm. Digital function were evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with 48 digits in excellent (average 11.2 points), 22 in good (average 8.1 points) and 5 in fair (average 5.4 points) and with a combined excellence and good rates of 93.33%. All flap donor sites were in normal function. For patient satisfaction: 53 patients were well satisfied, 21 were fairly satisfied and 1 was dissatisfied.Conclusion:Application of the island flap with dorsal branch of proper palmar digital nerve with fascio-pedicled in reconstruction of the defect of digital pulp has a high survival rate, simple surgical operation, good satisfactory outcome, with the digital artery being remained intact.

Objective To study the effects of an abnormal mechanical load in the developmental dysplasia of the hip(DDH)on the bone microstructure and blood vessels of the subchondral bone,and the correlation between bone microstructure and blood vessels.Methods A newborn rat DDH model was constructed using the swaddling method.Histological staining such as hematoxylin-eosin staining,safranin-fast green staining,and immunohistochemical staining was performed on the articular cartilage and subchondral bone of the femoral head.The microstructure of the subchondral bone was analyzed using microcomputed tomography(micro-CT).Results The DDH rats showed degeneration of the articular cartilage accompanied by deterioration of the microstructure of the subchondral bone,decreased bone formation,and increased vascular formation.The level of vascular formation in the subchondral bone was positively correlated with the degree of deterioration of the bone microstructure.Conclusions An abnormal mechanical load in the DDH causes articular cartilage degeneration,increased vascular formation in the subchondral bone,and subchondral bone microstructure deterioration.The correlation analysis revealed that the abnormal vascular formation in the subchondral bone may be an important factor causing the deterioration of bone microstructure and progression of DDH.This study has provided a new direction for the development of DDH.

Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease with a high prevalence of high prevalence,mainly manifested by hyperglycemia,insulin secretion or insulin resistance,often complicated by hypertension,hyperlipidemia and other metabolic abnormalities.In recent years,the association between intestinal flora,bile acids and T2DM has been a hot topic in clinical research.Traditional Chinese medicine believes that the spleen and stomach belong to soil,liver and gallbladder belong to wood,spleen soil stagnation,soil internal heat,affecting the drainage of liver wood;The liver wood is staggered,Liver qi stagnation,the middle scorch is suppressed,and finally the spleen is stagnant,which is the image of"earth stagnation,wood depression".Earth stagnation and wood depression are the cause and effect of each other,which is the theoretical basis for the occurrence and development of T2DM,and earth stagnation cannot transport water valley to nourish liver wood,and the liver loses nourishment,resulting in liver qi loss in drainage,qi depression and fire injury yin,burning lungs,robbing gastric juice,consuming kidney water,and inducing thirst quenching.From the perspective of modern medicine and biotechnology,the intestinal flora-bile acid metabolic axis is used as the starting point to explain the scientific connotation of the theory of soil wood.Intestinal flora disorder is an important biological basis of the soil,the spleen and soil are stagnant,the water valley does not change,affecting the body's digestion,immunity,lipids and other aspects,resulting in intestinal flora disorders.Abnormal bile acid metabolism is an important microscopic embodiment of wood depression,liver loss and drainage,gas engine lifting and lowering abnormalities,resulting in bile depression,bile acid metabolism secretion abnormal.The intestinal microbiota-bile acid metabolism axis regulates glucose metabolism and glucose homeostasis by affecting the structural composition and diversity of intestinal flora and bile acid pool composition in T2DM patients,thereby affecting the development process of diabetes.Therefore,this paper discusses the biological connotation of T2DM"earth stagnation,wood depression"from the perspective of intestinal microbiota-bile acid metabolic axis,better explains the scientific nature of T2DM soil woody depression mechanism,and provides new clinical ideas and theoretical basis for the prevention and treatment of T2DM.

Objective To observe the regulatory effects of Yitangkang on neuroinflammation and polarization of microglia and astrocytes in db/db mice;To explore the its mechanism in the treatment of cognitive impairment in diabetes.Methods Totally 32 db/db mice were randomly divided into model group,liraglutide group,and Yitangkang low-and high-dosage group.Another C57BL/6 mice were taken as blank group,with 8 mice in each group.Yitangkang low-and high-dosage group were given Yitangkang Decoction 15,30 g/kg respectively,the liraglutide group was intraperitoneally injected with liraglutide 200 μg/kg,the blank group and model group were given the same volume of distilled water by gavage,for 5 weeks.FJC staining was used to observe the damage of hippocampal neurons,ELISA was used to detect the content of IL-6 and IL-1β in hippocampal tissue,immunohistochemistry was used to detect the expressions of IL-6,IL-1β,Iba1 and GFAP in hippocampal tissue,the expressions of CD86,CD206,C3,S100A10,NLRP3,Iba1 and GFAP were detected by immunofluorescence,the protein expressions of CD86,CD206,C3,S100A10 and NLRP3 in hippocampal tissue were detected by Western blot.Results Compared with the blank group,the FJC positive cells in the model group significantly increased,and the contents of IL-6 and IL-1β significantly increased,the expressions of Iba1,CD86,GFAP and C3 significantly increased,CD206 and S100A10 expressions significantly decreased,NLRP3 protein expression and co-expression with Iba1 and GFAP significantly increased,with statistical significance(P<0.05,P<0.01).Compared with the model group,the FJC positive cells in hippocampal tissue of liraglutide group and Yitangkang low-and high-dosage group significantly decreased,the contents of IL-6 and IL-1β significantly decreased,the expressions of Iba1,CD86,GFAP and C3 significantly decreased,the expressions of CD206 and S100A10 significantly increased,the expression of NLRP3 protein and co-expression with Iba1 and GFAP were significantly decreased,the differences were statistically significant(P<0.05,P<0.01)except for CD206 in Yitangkang low-dosage group.Conclusion Yitangkang can effectively regulate the expression of NLRP3 in db/db mice,promote the transformation of microglia/astrocytes from M1/A1 type to M2/A2 type,inhibit the inflammatory response,and exert neuroprotective effects.