This article systematically reviews the current research status as well as diagnosis and treatment strategies of traditional Chinese medicine （TCM） for gastroesophageal reflux disease （GERD）. Studies demonstrate that TCM， based on the "disease-syndrome combination" approach， exhibits multi-target advantages in alleviating symptoms of various GERD subtypes， promoting mucosal repair， regulating emotions， and facilitating the reduction of western medication. To address clinical challenges such as symptom overlap and limited therapeutic efficacy， strategies have been proposed including "treating different diseases with the same method" and integrated regulation based on viscera correlation. Future efforts should focus on elucidating the mechanisms of compound prescriptions， promoting TCM drug development under the "three-combination" evaluation framework that integrates TCM theory， human experience and clinical trial evidence， and optimizing integrated traditional and western medicine models to enhance GERD management.

Objective To explore the feasibility and safety of transumbilical laparoendoscopic single-site surgery(TU-LESS)in the treatment of gynecologic malignant neoplasms.Methods The data of 363 patients with gynecologic malignant neoplas from November 2017 to October 2021 were collected for retrospective study.There were 123 cases of endometrial cancer[4 cases of robotic TU-LESS(R-TU-LESS)],211 cases of cervical cancer(16 cases of R-TU-LESS),and 29 cases of ovarian cancer(1 case of R-TU-LESS).Data collection included operation-related characteristics,postoperative rehabilitation indicators and oncological outcomes.Results ①Feasibility:the surgical conversion rate of the three groups was 3.3%(4/123),4.3%(9/211),and 6.9%(2/29),and the average operation duration was(213.8±64.3)min,(288.8±85.6)min,and(307.0±73.6)min,respectively.②Safety:the median value of blood loss during surgery of the three groups was 50(50,100)ml,100(50,200)ml,and 100(65,325)ml,the intraoperative complications rate was 3.3%(4/123),4.7%(10/211),and 17.2%(5/29),the postoperative complications rate was 7.3%(9/123),11.4%(24/211),and 17.2%(5/29),the median follow up time was 42.1(23.3,69.6)months,41.5(23.3,70.6)months,and 39.9(23.1,65.5)months,the five-year disease-free survival(DFS)was 92.3%,93.3%,and 84.4%,and the five-year overall survival(OS)was 96.8%,94.5%,and 88.5%,respectively.Conclusion TU-LESS is a safe and feasible approach for the treatment of gynecologic malignant neoplasms.

Objective To explore the feasibility and safety of transumbilical laparoendoscopic single-site surgery(TU-LESS)in the treatment of gynecologic malignant neoplasms.Methods The data of 363 patients with gynecologic malignant neoplas from November 2017 to October 2021 were collected for retrospective study.There were 123 cases of endometrial cancer[4 cases of robotic TU-LESS(R-TU-LESS)],211 cases of cervical cancer(16 cases of R-TU-LESS),and 29 cases of ovarian cancer(1 case of R-TU-LESS).Data collection included operation-related characteristics,postoperative rehabilitation indicators and oncological outcomes.Results ①Feasibility:the surgical conversion rate of the three groups was 3.3%(4/123),4.3%(9/211),and 6.9%(2/29),and the average operation duration was(213.8±64.3)min,(288.8±85.6)min,and(307.0±73.6)min,respectively.②Safety:the median value of blood loss during surgery of the three groups was 50(50,100)ml,100(50,200)ml,and 100(65,325)ml,the intraoperative complications rate was 3.3%(4/123),4.7%(10/211),and 17.2%(5/29),the postoperative complications rate was 7.3%(9/123),11.4%(24/211),and 17.2%(5/29),the median follow up time was 42.1(23.3,69.6)months,41.5(23.3,70.6)months,and 39.9(23.1,65.5)months,the five-year disease-free survival(DFS)was 92.3%,93.3%,and 84.4%,and the five-year overall survival(OS)was 96.8%,94.5%,and 88.5%,respectively.Conclusion TU-LESS is a safe and feasible approach for the treatment of gynecologic malignant neoplasms.

Objective To explore the value of coronary fat attenuation index(FAI)combined with laboratory indicators in predicting the risk of acute coronary syndrome(ACS)in patients with coronary heart disease(CHD).Methods A retrospective analysis was conducted on 454 patients who were diagnosed with CHD in Guangdong Provincial People's Hospital SCAD group(n=233)and an ACS group(n=221).Univariate and multivariate Logistic regression analyses were performed on the FAI values of the main coronary branches[right coronary artery(RCA),left anterior descending branch(LAD),left circumflex branch(LCX)],laboratory indicators,and clinical data,to identify independent risk factors for ACS in CHD patients.Receiver operating characteristic curves were constructed,and area under the curve(AUC)was calculated to evaluate the predictive performance of the independent risk factors and their combinations.Results LAD-FAI,RCA-FAI,and high-sensitivity C-reactive protein(hs-CRP)were independent influencing factors for ACS in CHD patients.The AUC for the prediction of ACS occurrence in CHD patients based on LAD-FAI,RCA-FAI,and elevated hs-CRP values alone were 0.568,0.703,and 0.749,respectively.When these three factors were analyzed in combination,the AUC was 0.815.Conclusion The combined analysis of LAD-FAI,RCA-FAI,and hs-CRP has good predictive performance for assessing the risk of ACS in CHD patients.

Objective To investigate the current situation and influencing factors of negative defensive medical practices among doctors in tertiary hospitals,construct a predictive model for negative defensive medicine.Methods Using cluster sampling,946 clinical doctors from 4 tertiary hospitals in Shandong Province were selected.A self-administered questionnaire was used to survey doctors'demographic characteristics,occupational characteristics,doctor-patient relationship status,and negative defensive medical behaviors.Logistic regression was used to screen the influencing factors of negative defensive medical behavior,while constructing a predictive model and analyzing the performance of the model.Results 72.1％ of doctors engaged in negative defensive medical practices,with the most common being reducing the number of patient contacts (671 people,70.9％).Logistic regression results showed that male gender,high seniority,high professional title,surgical specialty,negative doctor-patient relationship,experience of medical disputes,and high-risk perception were independent influencing factors for negative defensive medical behaviors (P<0.05).The logistic regression model incorporating the above 6 variables had an AUC of 0.846,good calibration,and a prediction accuracy of 88.6％ on the validation sample.Conclusion Negative defensive behavior is prevalent among doctors in tertiary hospitals.Interventions should focus on key populations and adopt targeted measures.The predictive model constructed in this study can be embedded into hospital management systems to achieve intelligent early warning.

Objective To investigate the current situation and influencing factors of negative defensive medical practices among doctors in tertiary hospitals,construct a predictive model for negative defensive medicine.Methods Using cluster sampling,946 clinical doctors from 4 tertiary hospitals in Shandong Province were selected.A self-administered questionnaire was used to survey doctors'demographic characteristics,occupational characteristics,doctor-patient relationship status,and negative defensive medical behaviors.Logistic regression was used to screen the influencing factors of negative defensive medical behavior,while constructing a predictive model and analyzing the performance of the model.Results 72.1％ of doctors engaged in negative defensive medical practices,with the most common being reducing the number of patient contacts (671 people,70.9％).Logistic regression results showed that male gender,high seniority,high professional title,surgical specialty,negative doctor-patient relationship,experience of medical disputes,and high-risk perception were independent influencing factors for negative defensive medical behaviors (P<0.05).The logistic regression model incorporating the above 6 variables had an AUC of 0.846,good calibration,and a prediction accuracy of 88.6％ on the validation sample.Conclusion Negative defensive behavior is prevalent among doctors in tertiary hospitals.Interventions should focus on key populations and adopt targeted measures.The predictive model constructed in this study can be embedded into hospital management systems to achieve intelligent early warning.

Objective:To systematically evaluate the clinical efficacy of oral ginger capsule or ginger powder in chemotherapy-induced nausea and vomiting in cancer patients.Methods:Computers searched Chinese Journal Full-text Database (CNKI), China Biomedical Literature Database (CBM), Wanfang Database, PubMed, EMbase, Web of Science, and Cochrane Library about oral chemotherapy in patients with cancer ginger correlation clinical curative effect of nausea and vomiting randomized controlled trial, supplemented by other search methods, the time range was built until July 2019. Quality evaluation and data extraction were performed independently by two investigators, and Meta analysis was performed by RevMan5.3 software.Results:A total of 12 articles and 13 studies were included, with a total of 1 105 patients. Meta-analysis showed that oral ginger capsule or ginger powder reduced the incidence of acute vomiting (risk ratio value was 0.76, 95% confidence interval was 0.59-0.98, P<0.05) and the severity of vomiting (mean difference value was-0.79, 95% confidence interval was-1.36--0.23, P<0.01), including the severity of acute vomiting (mean difference value was-1.39, 95% confidence interval was-2.72--0.06, P<0.05) and the severity of delayed vomiting (mean difference value was-0.46, 95% confidence interval was-0.82--0.10, P<0.05). However, there was no significant difference between the two groups in the incidence and severity of acute and delayed nausea ( P>0.05). Conclusions:This study demonstrates that oral ginger capsule or ginger powder is a complementary treatment for chemotherapy-induced nausea and vomiting in cancer patients, and more high-quality studies are needed to validate its clinical efficacy in the future.

Objective:To study the potential effects of intensity modulated radiation therapy (IMRT) on clinical efficacy,oral mucosa reaction and immunological foundation;and to explore the effect of immunological changes on clinical efficacy and oral mucosa reaction in patients with nasopharyngeal carcinoma.Methods:A total of 200 patients with nasopharyngeal carcinoma,who came from First Department of Nasopharyngeal Radiotherapy,the First People's Hospital of Foshan from October 2008 to November 2011,were selected.The patients were treated with nasopharyngeal radiotherapy,and divided into an observation group and a control group (n=100 in each group).The control group underwent common conventional two-dimensional radiotherapy treatment,while the observation group underwent IMRT.The 5-year survival rates and recurrence rates were recorded at follow-up.After the radiotherapy,the oral mucosa in the patients were evaluated by the classification standard of acute radioactive mucositis by American Radiotherapy Oncology Group (RTOG),and the number of T lymphocyte subsets before and after treatment was detected.Results:There were significant difference in non-regional-recurrence survival rate,disease-free survival rate,local recurrence rate between the above 2 groups (all P＜0.05),but no significant difference in the distant metastasis-free survival rate (P＞0.05).The acute oral mucosa reactions of grade 1,2,3,4 in the control group were 8.00％,20.00％,12.00％,7.00％,respectively,and those were 7.00％,22.00％,15.00％,1.00％ respectively.There was no significant difference in the acute response of oral mucosa in grade 1,2 and 3 in the 2 groups (all P＞0.05),but there was significant difference in the grade 4 (P＜0.05).There were significantly difference in CD8+,CD4+/CD8+ and CD4+ T lymphocyte subsets before and after treatment in the above 2 groups (all P＜0.01);there were also significantly difference after treatment between the observation group and the control group (all P＜0.01).Conclusion:In the process of treatment in patients with nasopharyngeal carcinoma,the use of IMRT on the basis of chemotherapy is more effective than the conventional two-dimensional radiotherapy,which can reduce the proportion of grade 4 (severe) acute oral mucosa reaction.It may be related to the protective effect of IMRT on immune function in the patients.

Objective To observe the morphology of embryonic stem cell-derived neurons after transplanted into A?-injured rat hippocampus. Methods Neural precursor cells (NPCs) were generated from mouse embryonic stem cells (ESCs) expressing EGFP with modified serum-free methods and then transplanted into the hippocampus of A?1-40-injuried rats. The morphology, neurotransmitter phenotypes and receptors of EGFP-positive donor cells were observed with immunofluorescene methods. Results The engrafted NPCs survived and differentiated into glutamatergic and GABAergic neurons and expressed both glutamatergic and GABAergic neurotransmitter receptors. Synaptophysin-positive dots were found surrounding somata and dendrites of transplanted neurons, suggesting the presence of presynaptic terminals adjacent to their membranes. Conclusion NPCs derived from ESCs can differentiate into excitatory and inhibitory neurons after grafted into Alzheimer's disease model rats, and maybe form synapse with the host neurons.