OBJECTIVES: This study aimed to explore the active components, potential targets, and mechanism of Cnidii Fructus in the treatment of periodontitis with osteoprosis through network pharmacology, molecular docking, and molecular dynamics simulation technology. METHODS: The main chemical constituents and targets of Cnidii Fructus were screened using the TCMSP and SwissTargetPrediction databases, as well as literature reports. Targets of periodontitis and osteoporosis were predicted using different databases. The intersection targets of Cnidii Fructus, periodontitis, and osteoporosis were obtained using Venny 2.1. The protein-protein interaction network was formed on the STRING platform. Cytoscape 3.9.1 was used to construct the active component-intersection target interaction network, perform the topological analysis, and screen key targets and core active components. Furthermore, the Metascape database was used to perform gene ontology (GO) function and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis on the intersection targets. The top five key targets and core active components were selected as receptor proteins and ligand small molecules. Discovery Studio 2019 was used to dock ligands and receptors and visualize the docking results. Molecular dynamics simulation was conducted using Gromacs2022.3 to assess the stability of the interactions between the core active components and the main targets. RESULTS: A total of 20 potential active ingredients of Cnidii Fructus were screened, and 116 targets of Cnidii Fructus were obtained for treating periodontitis and osteoporosis. GO and KEGG analyses of the 116 targets showed that Cnidii Fructus may play a therapeutic role through the phosphoinositide 3-kinase-protein kinase B (PI3K-Akt) and advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE) signaling pathways. Molecular docking showed that the core constituents were well bound to the main targets. Molecular dynamics simulations confirmed the stability of the Diosmetin-AKT1 complex system. CONCLUSIONS The preliminary discovery of the potential molecular pharmacological mechanism of Cnidii Fructus extract in the targeted treatment of periodontitis with osteoporosis through a multi-component, multitarget, and multi-pathway approach can serve as a theoretical foundation for future drug-development research and clinical application.
Molecular Docking Simulation ; Molecular Dynamics Simulation ; Network Pharmacology ; Periodontitis/complications* ; Drugs, Chinese Herbal/chemistry* ; Osteoporosis/complications* ; Humans ; Protein Interaction Maps ; Cnidium/chemistry*

Objective To investigate the application value of different doses of remifentanil combined with sevoflurane under pain threshold index(PTi)monitoring in ambulatory laparoscopic cholecystectomy.Methods 152 patients undergoing laparoscopic cholecystectomy under general anesthesia were selected from December 2023 to June 2024 at the Second Affiliated Hospital of Kunming Medical University.Patients were randomly divided into R1 group(n=38),R2 group(n=38),R3 group(n=38),and R4 group(n=38)using a random number table.On the basis of sevoflurane at 0.7 minimum alveolar concentration(MAC),patients in R1～R4 groups were combined with 0.1,0.2,0.3,and 0.4 μg/kg·min remifentanil,respectively.The changes in PTi at different time points,pre-and post-operative blood stress indicators[cortisol(Cor),norepinephrine(NE),and blood glucose(Glu)concentrations]were compared,and the incidence of intraoperative hypertension,hypotension,tachycardia,bradycardia,and postoperative nausea and vomiting were recorded.Results Compared with R1 group,PTi in R2,R3,and R4 groups decreased from the start of surgery(T3)to 5 min after extubation(T11)(P<0.05);compared with R2 group,PTi in R3 and R4 groups was lower at T3～T11(P<0.05);no statistically significant difference was found in PTi changes between R3 and R4 groups at different time points(P>0.05).Postoperative Cor,NE,and Glu concentrations showed statistically significant differences among the four groups(P<0.001),but no significant difference was found preoperatively(P>0.05).Compared with preoperative values,Cor,NE,and Glu levels significantly increased in all groups(P<0.001),with R1 group>R2 group>R4 group>R3 group.The incidence of intraoperative hypertension,hypotension,bradycardia,and tachycardia showed statistically significant differences(P<0.001),with R4>R1>R2=R3.The incidence of postoperative nausea and vomiting also showed statistically significant differences(P<0.001),with R1 group>R4 group>R2 group>R3 group.Conclusion Sevoflurane at 0.7 MAC combined with 0.3 μg/kg·min remifentanil provides good analgesic effects for patients undergoing ambulatory laparoscopic cholecystectomy,reduces stress response,and has high safety,making it worthy of clinical promotion.

Objective:To systematically evaluate the efficacy of ATP bioluminescence technology versus traditional microbiology detection method in assessing flexible endoscope cleaning and disinfection.Methods:Eight Chinese and English databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Chinese Medical Journal Database and China Biology Medicine disc, were searched from inception to October 1, 2023. Comparative studies on evaluating post-reprocessing endoscope quality using both methods were included. Positive sample numbers and positive rates were taken as the main effect indicators, and the fixed effect model was used to conduct a meta-analysis of the included literature.Results:A total of 14 Chinese and English articles were included, involving 4 569 samples (gastroscopes, colonoscopes, duodenoscopes and fiberbronchoscopes). The pooled analysis demonstrated low heterogeneity across studies ( I2=23%), with a combined odds ratio ( OR) of 1.57 (95% CI: 1.27-1.94). It indicated a statistically significant difference in positive detection rates between the two methods ( P<0.001). However, funnel plot analysis suggested potential publication bias. Conclusion:ATP bioluminescence correlates with microbiological methods for monitoring endoscope reprocessing. While ATP offers rapid assessment advantages, its consistently higher positive rates preclude replacement of conventional microbiological verification for terminal disinfection.

Objective:To systematically evaluate the efficacy of ATP bioluminescence technology versus traditional microbiology detection method in assessing flexible endoscope cleaning and disinfection.Methods:Eight Chinese and English databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Chinese Medical Journal Database and China Biology Medicine disc, were searched from inception to October 1, 2023. Comparative studies on evaluating post-reprocessing endoscope quality using both methods were included. Positive sample numbers and positive rates were taken as the main effect indicators, and the fixed effect model was used to conduct a meta-analysis of the included literature.Results:A total of 14 Chinese and English articles were included, involving 4 569 samples (gastroscopes, colonoscopes, duodenoscopes and fiberbronchoscopes). The pooled analysis demonstrated low heterogeneity across studies ( I2=23%), with a combined odds ratio ( OR) of 1.57 (95% CI: 1.27-1.94). It indicated a statistically significant difference in positive detection rates between the two methods ( P<0.001). However, funnel plot analysis suggested potential publication bias. Conclusion:ATP bioluminescence correlates with microbiological methods for monitoring endoscope reprocessing. While ATP offers rapid assessment advantages, its consistently higher positive rates preclude replacement of conventional microbiological verification for terminal disinfection.

Xianfang Huomingyin is known as the first prescription of surgery， also known as Shenxian Huomingyin and Zhenren Huomingyin. The earliest one was from Renzhai Zhizhi in the Southern Song dynasty. It was composed of 13 mainstream medicines such as Angelicae Dahuricae Radix， Saposhnikoviae Radix， Paeoniae Radix Rubra， and three modified medicines such as Rhei Radix et Rhizoma， Momordicae Semen and Astragali Radix. It has the effects of clearing heat and detoxifying， detumescence and ulceration， promoting blood circulation and relieving pain， and is mainly used to treat Yang syndrome. In this study， the bibliometrics method was used to systematically study the historical evolution， prescription composition， dosage， indications， decocting methods， administration methods， drug processing and ancient and modern applications of Xianfang Huomingyin. As for the drug origin， pangolin is consistent with the 2015 edition of Chinese Pharmacopoeia， the origins of the remaining drugs are consistent with the 2020 edition of Chinese Pharmacopoeia. According to the ancient and modern dosage conversion， the dosage of each drug is as follows：Angelicae Dahuricae Radix， Paeoniae Radix Rubra， Fritillariae Thunbergii Bulbus， Glycyrrhizae Radix et Rhizoma and Trichosanthis Radix， Olibanum of 4.13 g， Gleditsiae Spina and Myrrha of 2.07 g， Angelicae Sinensis tail（stir-fried with wine） and Citri Reticulatae Pericarpium of 6.2 g， Saposhnikoviae Radix（removing reed） of 2.89 g， pangolin（stir-fried with clam powder） of 4.14 g， Lonicerae Japonicae Flos of 12.39 g， or adding Rhei Radix et Rhizoma of 4.13 g and Momordicae Semen（shelled） of 3.3 g， adding Astragali Radix of 4.13 g for body deficiency. The above medicines were decocted with 450 mL of yellow rice wine to 300 mL， 1 dose for each time， 3 doses for each day， and warmed before or 0.5 h after meals， 1-6 doses， and discontinue medication as soon as get effect. Because this formula is easy to hurt the spleen and stomach， it should not be taken more. In the follow-up， it should be used in conjunction with Tuoli Xiaodusan， and other related symptoms of patients can be further improved through dialectical addition and subtraction. This formula has the efficacy of disinfection and pus discharge， removing blood stasis and relieving pain. All carbuncle gangrene without ulceration at the beginning， and for the empirical and heat syndrome. Modern applications involve more than 200 kinds of diseases with heat syndrome， emergency and excess syndrome as the main syndrome differentiation points in dermatology， peripheral vascular department and other departments. In a word， this paper studies the literature of Xianfang Huomingyin in order to provide a basis for its wider and deeper clinical application and development research.

Animals ; Macaca mulatta ; Optic Disk ; Glaucoma ; Craniocerebral Trauma ; Intraocular Pressure ; Low Tension Glaucoma

Background::To date, there is still a lack of standardized management strategies for gastric low-grade dysplasia (LGD), which is a direct neoplastic precancerous lesion and requires specifically superficial destruction. Radiofrequency ablation (RFA) is expected to be an effective method for gastric LGD, but post-RFA pain may affect patients’ satisfaction and compliance. The current study aimed to evaluate the value of a submucosal injection prior to RFA (SI-RFA) for postoperative pain and treatment outcomes.Methods::Between October 2014 and July 2021, gastric LGDs without risk factors (size >2 cm, unclear boundary, and abnormal microsurface and microvascularity) undergoing regular RFA and SI-RFA were retrospectively analyzed. Postoperative pain scores, wound healing, and clinical efficacy were compared. Propensity score matching, stratified analysis, and multivariable logistic regression were performed to control the confounding variables.Results::One hundred and ninety-seven gastric LGDs in 151 patients received regular RFA. Forty-nine gastric LGDs in 36 patients received SI-RFA. Thirty-six pairs of patients were selected for the assessment of postoperative pain by propensity score matching. Compared to regular RFA, SI-RFA significantly decreased the degree and duration of postoperative pain (OR, 0.32; 95% CI, 0.13-0.84; P = 0.020), improved wound healing rate (80.0% [36/45] vs. 58.9% [89/151], P = 0.012), increased the complete ablation rate (91.8% [45/49] vs. 86.3% [170/197], χ 2 = 1.094, P = 0.295), but correlated with higher rates of local recurrence and progression (25.6% [10/39] vs. 13.2% [18/136], χ 2 = 3.471, P = 0.062; 8.3% [3/36] vs. 0.9% [1/116], P = 0.042). The multivariable logistic regression model confirmed that submucosal injection was associated with local recurrence (OR, 2.93; 95% CI, 1.13-7.58; P = 0.027). Conclusions::Submucosal injections prior to RFA may reduce postoperative pain and scar formation while ensuring complete ablation of gastric LGD. However, local recurrence and progression should be considered seriously.

Background::Endoscopic papillectomy (EP) is recommended as the first-line therapy for ampullary tumors, despite a relatively high incidence of complications. Pancreatic and/or biliary stents are placed at the endoscopist’s discretion to prevent post-EP complications. The present study aimed to evaluate the efficacy of different stents.Methods::A total of 117 patients who underwent EP and met the criteria between June 2006 and October 2022 were enrolled in the study. These patients were divided into a pancreatic stent group (PS group, n = 47), a biliary stent group (BS group, n = 38), and a two-stent group (PBS [PS and BS] group, n = 32). Relevant clinical data were collected and compared among the three groups. Multivariate logistic analyses were performed to explore risk factors for post-EP complications. Results::The incidence of all complications was 37.6% (44/117). Pancreatitis and hemorrhage were the two most common complications with incidence rates of 14.5% (17/117) and 17.9% (21/117). The incidence rates of post-EP pancreatitis were 10.6% (5/47), 23.7% (9/38), and 9.4% (3/32) in the PS group, BS group, and PBS group, respectively, with no significant differences. There were also no significant differences in other complications among the three groups. Age (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.91-0.99; P = 0.022) was independently associated with post-EP pancreatitis while tumor size (OR: 1.66; 95% CI: 1.06-2.60; P = 0.028) was independently associated with post-EP hemorrhage. Conclusions::While pancreatic stenting is the first choice to prevent post-EP pancreatitis, biliary stenting could also be considered as a substitute for patients with difficulties in pancreatic cannulation. Two-stent (biliary and pancreatic stent) placement is unnecessary unless it is required due to other concerns.

Background::Biliary tract carcinoma (BTC) is relatively rare and comprises a spectrum of invasive tumors arising from the biliary tree. The prognosis is extremely poor. The incidence of BTC is relatively high in Asian countries, and a high number of cases are diagnosed annually in China owing to the large population. Therefore, it is necessary to clarify the epidemiology and high-risk factors for BTC in China. The signs associated with BTC are complex, often require collaborative treatment from surgeons, endoscopists, oncologists, and radiation therapists. Thus, it is necessary to develop a comprehensive Chinese guideline for BTC.Methods::This clinical practice guideline (CPG) was developed following the process recommended by the World Health Organization. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty of evidence and make recommendations. The full CPG report was reviewed by external guideline methodologists and clinicians with no direct involvement in the development of this CPG. Two guideline reporting checklists have been adhered to: Appraisal of Guidelines for Research and Evaluation (AGREE) and Reporting Items for practice Guidelines in Healthcare (RIGHT).Results::The guideline development group, which comprised 85 multidisciplinary clinical experts across China. After a controversies conference, 17 clinical questions concerning the prevention, diagnosis, and treatment of BTC were proposed. Additionally, detailed descriptions of the surgical principles, perioperative management, chemotherapy, immunotherapy, targeted therapy, radiotherapy, and endoscopic management were proposed.Conclusions::The guideline development group created a comprehensive Chinese guideline for the diagnosis and treatment of BTC, covering various aspects of epidemiology, diagnosis, and treatment. The 17 clinical questions have important reference value for the management of BTC.

Objective:To analyze the differences in clinical and endoscopic ultrasonography (EUS) findings between diffuse and focal IgG4-related autoimmune pancreatitis (IgG4-AIP).Methods:Data of patients diagnosed as having IgG4-AIP who underwent EUS at Chinese PLA General Hospital from September 2011 to April 2022 were retrospectively collected. General clinical data, EUS features, and postoperative pathology were analyzed for characteristic differences.Results:A total of 40 patients were included in the study, 60.03±10.87 years old, a higher proportion of males (85.0%, 34/40). All patients underwent EUS, and 28 underwent EUS-guided fine-needle aspiration. Among the 40 patients, 29 (72.5%) had diffuse type and 11 (27.5%) had focal type. Abdominal pain [65.5% (19/29) VS 18.2% (2/11), χ2=5.393, P=0.020] and thickening of the bile duct wall [51.7% (15/29) VS 9.1% (1/11), χ2=4.394, P=0.036] were more common in the diffuse type, while main pancreatic duct dilation [45.5% (5/11) VS 10.3% (3/29), χ2=4.146, P=0.042] was more common in the focal type, with the lesion most commonly located in the pancreatic head (90.9%, 10/11). There was no significant difference in the presence of chronic pancreatitis parenchymal changes between the two groups [34.5% (10/29) VS 27.3% (3/11), χ2=0.003, P=0.955]. Conclusion:There are certain differences in abdominal pain and biliary and pancreatic duct lesions between diffuse and focal AIP. The high expression of chronic pancreatitis characteristics is not observed in either group, which provides clues for the classification of AIP in clinical practice.