Employing bibliometric methods and adhering to principles of textual research， this study systematically investigated prescription source， formula name， composition evolution， dose evolution， origin， processing， ancient and modern applications of Xiaofengsan. Xiaofengsan， also known as Renshen Xiaofengsan and Chantui Xiaofengsan， was first recorded in the Taiping Huimin Hejijufang（hereafter referred to as Jufang） of the Southern Song dynasty. The formula composition included Schizonepetae Spica， Glycyrrhizae Radix et Rhizoma， Chuanxiong Rhizoma， Notoptery Rhizoma et Radix， Bombyx Batryticatus， Saposhnikoviae Radix， Poria， Cicadae Periostracum， Pogostemonis Herba， Ginseng Radix et Rhizoma， Magnoliae Officinalis Cortex and Citri Reticulatae Pericarpium， a total of 12 medicinal materials. In terms of the evolution of formula composition， formulas across dynasties largely aligned with those recorded in Jufang， with only minor variations in application. The results of the formula dosage research indicated that one dose of medication in Jufang corresponded to the following modern dosages：Schizonepetae Spica of 82.6 g， Glycyrrhizae Radix et Rhizoma of 82.6 g， Chuanxiong Rhizoma of 82.6 g， Notoptery Rhizoma et Radix of 82.6 g， Bombyx Batryticatus of 82.6 g， Saposhnikoviae Radix of 82.6 g， Poria of 82.6 g， Cicadae Periostracum of 82.6 g， Pogostemonis Herba of 82.6 g， Ginseng Radix et Rhizoma of 82.6 g， Magnoliae Officinalis Cortex of 20.65 g and Citri Reticulatae Pericarpium of 20.65 g， the origins of all the constituent drugs were consistent with the 2020 edition of Pharmacopoeia of the People's Republic of China. The results of the investigation into the decoction method indicated that the aforementioned drugs should be finely ground into powder（pass through the No.5 sieve）， and 8.26 g was taken for each dose， which was taken with the clear liquid obtained by steeping tea leaves in boiling water for several minutes. This mixture was administered three times daily， 30 min after meals. The ancient functional indications of this formula mainly involved dispelling wind-heat， eliminating pathogenic factors and regulating the middle Jiao. It primarily treated all wind-heat syndromes manifesting as skin diseases， predominantly affecting the upper body， especially the head and face. The diseases involved in modern applications were mostly dermatological diseases， including urticaria， eczema， atopic dermatitis and others. In this paper， by combing the relevant ancient literature， the key information of Xiaofengsan was textual researched， in order to provide reference for the modern application and development of this formula.

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 explore the application of psychological stress theory in endoscopic dilatation in patients with esophageal stricture.Methods A total of 110 patients who underwent endoscopic dilatation for esophageal stricture in Jiangsu Provincial People's Hospital from September 2019 to January 2021 were selected as research objects.They were divided into control group and observation group according to random number table method,with 55 cases in each group.The control group implemented conventional psychological intervention,and the observation group implemented conventional psychological intervention and the intervention based on psychological stress theory.The level of stress disorder,psychological resilience,and rehabilitation status were evaluated by the Post Traumatic Stress Disorder Self-Rating Scale(PTSD-SS),Connor-Davidson Resilience Scale(CD-RISC),and Morningside Rehabilitation Status Scale(MRSS)before intervention,on the day 3 of intervention,and 1 week after intervention.Results Repeated measure ANOVA showed that there were time,group,time-group interactions in the scores of PTSD-SS,CD-RISC,and MRSS in patients undergoing endoscopic dilatation for esophageal stricture when psychological intervention based on psychological stress theory was applied(P<0.05).Conclusion The intervention based on psychological stress theory can relieve the stress disorder in patients undergoing endoscopic dilatation for esophageal stricture,restore the psychological resilience,and promote postoperative recovery.

ObjectiveTo observe the effectiveness and safety of the Chinese herbal medicine Mingshi Granules （明视方颗粒） for low myopia in children with heart yang insufficiency. MethodsA multicentre， prospective， double-blind randomised controlled study was conducted， in which 290 children with low myopia from 8 centres were randomly divided into 145 cases in the treatment group and 145 cases in the control group， and the treatment group was given education， dispensing glasses， and Chinese herbal medicine Mingshi Granules， while the control group was given education， dispensing glasses， and granules placebo. Both Mingshi Granules and placebo granules were taken orally， 1 bag each time， twice daily， 4 weeks of oral intake and 2 weeks of rest as 1 course of treatment， a total of 4 courses of treatment （24 weeks）. Equivalent spherical lenses， best naked-eye distance visual acuity， ocular axis， corneal curvature K1， adjustment amplitude， traditional Chinese medicine （TCM） symptom scores， calculate the amount of progression of equivalent spherical lenses， were observed at the 12th and the 24th week of treatment， at the 36th week and 48th week of follow-up， resectively， the control rate of myopia progression was evaluated at the 24th week， and safety indexes were observed before treatment. ResultsThe amount of progression of equivalent spherical lenses was lower in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The control rate of myopia progression at 24 weeks after treatment in the treatment group was higher （57.60%， 72/125） than that in the control group （44.63%， 54/121） （P＜0.05）. The best naked-eye distance visual acuity at 36-week follow-up in the treatment group was higher than that in the control group （P＜0.05）. Equivalent spherical lenses were significantly lower in both groups at all observation time points compared with pre-treatment （P＜0.05）， and were higher in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The ocular axes of both groups were significantly higher at each observation time point after treatment and at follow-up compared with before treatment （P＜0.05）. The amount of eye axis growth in the treatment group was lower than that in the control group at 24 weeks after treatment and at the 48-week follow-up （P＜0.05）. Corneal curvature K1 was significantly lower in the treatment group at the 24th week of treatment compared to pre-treatment （P＜0.05）. The magnitude of adjustment in the treatment group was significantly higher at the 36-week follow-up and at the 48-week follow-up than before treatment （P＜0.05）. The scores of white/dark complexion， white coating thin pulse， fatigue and total TCM symptom scores of children in both groups at the 12th， 24th， 36th and 48th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； the scores of blurred vision at the 24th and 36th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； and the scores of blurred vision in the treatment group at the 48th week of follow-up were signi-ficantly lower than those before treatment （P＜0.05）. In the treatment group， the score of fatigue was higher than that of the control group at the 36-week follow-up， and the score of blurred vision was lower than that of the control group at the 48-week follow-up （P＜0.05）. No adverse reactions or obvious abnormalities of the safety indexes were observed of the two groups during the treatment. ConclusionChinese herbal medicine Mingshi Granules showed the effect of controlling the progression of low myopia， improving the best naked eye distance visual acuity， slowing down the growth of the eye axis， improving some of the TCM symptoms， with good safety.

The clinical decision in bariatric and metabolic surgery is influenced by several factors. Both patients and medical providers face conflicts when deciding whether to proceed with the surgery and which procedure to choose. Some clinical decision-making studies have provided high-level evidence to assist in selecting patients and surgical methods. Additionally, there are clinical decision support systems tailored to the needs of this specialty. However, there is currently a lack of a high-level clinical decision system for bariatric and metabolic surgery in China. The authors refer to previous research progress and conduct in-depth discussions on the clinical decision-making of bariatric and metabolic surgery based on patient selection and surgical method selection.

Objective:To investigate the surgical decision-making types and its influencing factors for obesity patients participating in bariatric metabolic surgery.Methods:The survey targets were patients who were scheduled to bariatric metabolic surgery in The First Affiliated Hospital of Nanjing Medical University, and the survey period was from January 1 to May 30, 2024. The survey was conducted using the general demographic questionnaire, control preference scale, and shared-decision requirements questionnaire for bariatric metabolic surgery. Count data were expressed as absolute numbers and percentages, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was performed using the non parametric test. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was conducted using the willingness of patients to participate in bariatric metabolic surgery decision-making (passive decision-making=1, shared decision-making=2, active decision-making=3) as the dependent variable, and the statistically significant variables in univariate analysis were included as independent variables for disordered multi-class Logistic regression analysis.Results:(1) Results of survey. A total of 568 questionnaires were distributed and collected. After removing 48 unqualified questionnaires, 520 valid questionnaires were collected. Of the 520 patients who completed the questionnaire survey, there were 231 cases participating as the passive decision-making type, 140 cases as shared decision-making type, and 149 as active decision-making type in bariatric metabolic surgery decision-making. (2) Influencing factors for decision-making type of obesity patients participating in bariatric metabolic surgery. Results of multivariate analysis showed that taking the shared decision-making type as a reference, the number of complication (0 compared to ≥4, 1?3 compared to ≥4), medical payment method (medical insurance compared to self-payment), degree of disease understanding (not very understanding compared to general understanding, not understanding compared to general understanding), and the interval between knowing and accep-ting surgery (1-3 months compared to >6 months) were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery deci-sions ( odds ratios=3.520, 2.457, 2.255, 3.147, 1.920, 1.854, 95% confidence interval as 1.552-7.984, 1.215-4.968, 1.335-3.809, 1.865-5.311, 1.025-3.596, 1.065-3.230, P<0.05). Body mass index (BMI) (28.0-31.9 kg/cm 2 compared to ≥37.0 kg/cm 2, 32.0-36.9 kg/cm 2 compared to ≥37.0 kg/cm 2), number of complication (0 compared to ≥4, 1?3 compared to ≥4), family and social support status (poor compared to good), and the interval between knowing and accepting surgery (1?3 months compared to >6 months) were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery decisions ( odds ratios=2.391, 2.478, 6.918, 3.335, 2.974, 2.139, 95% confidence intervals as 1.207-4.735, 1.345-4.563, 2.498-19.159, 1.350-8.242, 1.755-5.039, 1.156-3.957, P<0.05). Taking the passive decision-making type as a reference, BMI (28.0-31.9 kg/cm 2 compared to ≥37.0 kg/cm 2, 32.0-36.9 kg/cm 2 compared to ≥37.0 kg/cm 2) and family social support status (poor compared to good) were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery decisions ( odds ratios=0.404, 0.554, 0.336, 95% confidence interval as 0.221-0.740, 0.327-0.938, 0.212-0.534, P<0.05). (3) Analysis of decision support needs for bariatric metabolic surgery. Results of shared-decision requirements questionnaire showed that the information needs of obesity patients from high to low were surgical indications, postoperative physical changes and dietary habits adjust-ments, surgical costs, surgical complications and risks, and surgical outcomes. The demand for content preference from high to low were in the form of sharing patient experience after bariatric metabolic surgery, comparing before and after bariatric metabolic surgery, popularizing science after bariatric metabolic surgery, introducing surgical methods, live streaming of medical staff, and introducing the hospital environment. In terms of recognition of networked support pathways, 94.04%(489/520) of patients believed that implementing shared decision support based on networked pathways was reliable. Conclusions:Obesity patients are more willing to participate in bariatric metabolic surgery decision-making. But the proportion of patients selecting passive decision-making is relatively high. BMI, number of complication, medical payment method, degree of disease under-standing, family and social support status and the interval between knowing and accepting surgery are independent factors influencing the willingness of obesity patients to paticipate in bariatric metabolic surgery decisions.

【Objective】 To compare the value of CT pulmonary angiography (CTPA) and echocardiography in predicting the degree pulmonary hypertension (PH). 【Methods】 Fifty-four patients in our hospital who underwent right heart catheterization, CTPA and echocardiography for suspected or confirmed PH from November 2013 to April 2021 were retrospectively recruited. Pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (PAMP) were measured by right heart catheterization. According to PAMP, the patients were divided into non-PH group and mild, moderate, and severe PH groups. The three-dimensional model of the pulmonary artery was obtained by computer-aided segmentation, and the best fitting circle diameter (Dfit), inscribed circle diameter (Dmin), circumscribed circle diameter (Dmax), hydraulic diameter (Dh), cross-sectional area (Area), circumference (Scf), and the largest area and largest short diameter of the right ventricle were measured. Echocardiography was used to estimate PASP. The differences in the above parameters between different PH groups were compared, the correlations of the above parameters with PASP and PAMP were analyzed, and statistically significant indicators were included to establish three predictive models of PAMP (Model 1: CTPA pulmonary artery; Model 2: CTPA pulmonary artery+CTPA right ventricle; Model 3: CTPA pulmonary artery+CTPA right ventricle+echocardiography), and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of the three models. 【Results】 Some parameters of main pulmonary artery (Dfit, Dmin, Dmax, Dh, Area, Scf), right pulmonary artery (Dmax, Dh, Area, Scf), left pulmonary artery (Dfit), and right ventricular short diameter increased with the increase of PAMP (P<0.05). Dfit, Dmin, Dh, and area of main pulmonary artery, right pulmonary artery and left pulmonary artery were positively correlated with PASP and PAMP (P<0.05). Right ventricular short diameter and right ventricular maximum area were positively correlated with PASP (P<0.05), and right ventricular short diameter was positively correlated with PAMP (P<0.05). The estimated value of pulmonary artery systolic blood pressure in echocardiography was positively correlated with PASP and PAMP (P<0.05). Model 1, Model 2 and Model 3 could all be used to identify mild PH and moderate PH, among which Model 3 had the best performance in identifying non-PH and mild PH, moderate PH and severe PH. 【Conclusion】 CTPA and echocardiography are helpful in assessing the degree of PH, and the combination of the two has better accuracy in distinguishing non-PH from mild PH, moderate and severe PH.

Objective To compare the effects of 4 different shaping angle tubes on the success rate of tracheal intubation and postoperative pharyngeal complications among anesthetic beginners.Methods 160 patients who underwent laparoscopic cholecystectomy under general anesthesia,with ASA classification Ⅰ to Ⅱ,no history of difficult airway,were randomly divided into 4 groups according to the catheter shape and tip shaping angle:35°banana-shaped elbow group(A Group),50°banana-shaped bent pipe group(Group B),35°straight pipe group(Group C),50°straight pipe group(Group D),with 40 cases in each group.After induction of general anesthesia,tracheal intubation is performed using a video laryngoscope.The Cormack-Lehane grade of laryngoscope exposure,external laryngeal compression,one-time success rate of intubation and intubation time were recorded.SPO2,HR and MAP were recorded before anesthesia induction(T0),at the end of anesthesia induction drug injection(T1),immediately after intubation(T2)and 1min after intubation(T3).The incidence of pharyngeal pain and hoarseness immediately after extubation and 24 hours after operation were followed up.Results There were no statistically significant differences in Cormack-Lehane classification,HR,and MAP among the four groups of patients at each time point(P>0.05).The number of cases requiring external laryngeal compression,intubation time,first-time intubation success rate,immediate postoperative sore throat,and immediate postoperative hoarseness rates in Groups B and D were all lower than those in Groups A and C,and the differences were statistically significant(P<0.05).Conclusion When using video laryngoscope for tracheal intubation,50°banana-shaped curved tube and 50°straight tube can shorten the intubation time,reduce postoperative complications,and have no obvious hemodynamic fluctuations.

Objective:To investigate the distribution of intraocular pressure (IOP) in high-altitude population aged 18 years and over in Xining, Qinghai and establish the reference interval (RI) of IOP.Methods:A cross-sectional study was conducted in Xining, Qinghai Province at 2.271 km above sea level from September 2019 to May 2020.Ophthalmic examinations and IOP measurement were conducted among subjects from Physical Examination Center of Qinghai Provincial People's Hospital.The subjects who had been living in Xining without leaving for three months were enrolled.Ophthalmic examinations included vision examination, IOP measurement, slit-lamp microscopy, fundus photography, anterior and posterior segment optical coherence tomography.IOP was measured using Goldmann applanation tonometry under local anesthesia.Subjects with factors that could cause significant changes in IOP and affect the accuracy of IOP measurement, and those who were unable to receive IOP measurement were excluded.Subjects were grouped according to sex, age and ethnicity, and the distribution and RI of IOP were compared among all groups.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2017-024). Written informed consent was obtained from each subject.Results:A total of 6 120 subjects (6 120 eyes) aged 18-90 years old were enrolled, including 2 850 males and 3 270 females with average age of (45.54±13.85) years.The average IOP of high-altitude population in Xining, Qinghai Province was (14.32±1.93) mmHg (1 mmHg=0.133 kPa), with the RI of 10.54-18.10 mmHg.The average IOP was (14.42±1.98) mmHg in male with the RI of 10.54-18.30 mmHg, (14.23±1.88) mmHg in female with the RI of 10.55-17.91 mmHg.The IOP of male was higher than that of female ( t=3.71, P<0.001). The IOP of Han, Tibetan, Hui and other nationalities were (14.38±1.91), (13.93±2.06), (14.21±1.87), (13.94±1.95) mmHg, respectively, with a statistically significant overall difference ( F=6.73, P<0.001). The IOP of Han nationality was significantly higher than that of Tibetan, Hui and other nationalities, and the differences were statistically significant (all at P<0.05). Conclusions:RI of IOP in high-altitude population from Xining, Qinghai is lower compared with normal altitude area.

Objective:To investigate the bleeding characteristic and influencing factors after bariatric surgery.Methods:The retrospective case-control study was conducted. The clinical data of 3 371 patients with obesity who underwent bariatric surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to August 2021 were collected. There were 903 males and 2 468 females, aged 31(16?65)years. Observation indicators: (1) occurrence, diagnosis and treatment of bleeding after bariatric surgery; (2) analysis of influencing factors for bleeding after bariatric surgery. (3) Follow-up. Follow-up was conducted through outpatient examinations, telephone interview or WeChat to detect total weight loss rate, resolution of hypertension and remission of type 2 diabetes of the patients with bleeding after bariatric surgery. The follow-up was up to August 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed by the chi-square test. Ordinal data were analzyed by the non-parametric rank sum test. Univariate analysis was conducted using the corresponding statistical methods based on data type. The binary Logistic regression was used for multivariate analysis. Results:(1) Occurrence, diagnosis and treatment of bleeding after bariatric surgery. There were 27 of 3 371 patients diagnosed with postoperative bleeding, including 13 males and 14 females. There were 18 cases of abdominal bleeding and 9 cases of gastrointestinal bleeding. Among the 27 patients with postoperative bleeding, 8 cases were diagnosed with bleeding on the day after operation, 13 cases were diagnosed on the first day after operation, 4 casess were diagnosed on the second day, and 2 cases were diagnosed on the third day or later. Among the 27 patients with postoperative bleeding, 24 cases had tachycardia as the main clinical manifestation, 11 patients had abnormal abdominal drainage with the drainage volume as 300(range, 100?600)mL, 6 cases had hematocheziain with the volume as 500(range, 120?1 000)mL, 5 cases were manifested as hypotension, 3 cases had hematemesis with the volume as 300(range, 50?800)mL, 2 cases had a significant decrease in hemoglobin on the first day after operation. One patient may have multiple clinical manifestations. Among the 27 patients with postoperative bleeding, 6 cases with abdominal bleeding received emergency laparotomy due to continuous increase of abdominal drainage or hemorrhagic shock, of which one patient died of heart failure after emergency reoperation. The time between primary and secondary operation was 13.5(range, 2.0?45.0)hours, and the volume of blood accumulation was 1 000(range, 600?7 000)mL. The bleeding sites were identified in 5 patients during reoperation, including 2 cases of staple line bleeding after sleeve gastrectomy, 1 case of lesser sac bleeding after Roux-en-Y gastric bypass, 1 case of short gastric vessel bleeding and 1 case of trocar site bleeding. One patient had no obvious active bleeding during reoperation. The remaining 12 cases of abdominal bleeding and 9 cases of gastrointestinal bleeding were treated by conservative therapy. The duration of bleeding lasted for (2.1±0.7)days. (2) Analysis of influencing factors for bleeding after bariatric surgery. Results of univariate analysis showed that gender, hypertension, type 2 diabetes, surgical type were the related factors that affected the bleeding after bariatric surgery ( χ2=6.33, 42.16, 4.49, 14.09, P<0.05). Results of multivariate analysis indicated that surgical type was a independent factor affecting postoperative bleeding in patients undergoing bariatric surgery ( odds ratio=1.69, 95% confidence interval as 1.18?2.41, P<0.05). (3) Follow-up. All the 27 patients were followed up for 16(1?62)months. Eighteen patients reached or exceeded the 12 months follow-up time point. The 1-year total weight loss rate was 36%±12%, the resolution proportion of hypertension was 8/11, and the complete remission proportion of type 2 diabetes was 6/7. Six patients reached or exceeded the 36 months follow-up time point. The 3-year total weight loss rate was 35%±12%, the resolution proportion of hypertension was 4/5, and the complete remission proportion of type 2 diabetes was 1/1. Conclusions:The incidence of post-operative bleeding after bariatric surgery is low. Tachycardia, abnormal abdominal drainage and hypotension have sentinel functions. Surgical type is a independent factor affecting bleeding after bariatric surgery.