Objective: To determine the clinical efficacy and mechanism of Piwei Peiyuan Pill (PPP) combined with moxibustion for treating patients with chronic atrophic gastritis (CAG) with spleen and stomach weakness syndrome. Methods: Ninety-six CAG patients with spleen and stomach weakness syndrome who met the inclusion and exclusion criteria were enrolled at the Department of Spleen and Stomach Diseases of the Second Affiliated Hospital of Anhui University of Chinese Medicine from June 2022 to December 2023. The patients were randomly divided into a control, a Chinese medicine, and a combined group using a random number table method, with 32 cases in each group (two cases per group were excluded). The control group was treated with rabeprazole combined with folic acid tablets (both thrice daily), the Chinese medicine group was treated with PPP (8 g, thrice daily), and the combined group was treated with moxa stick moxibustion (once daily) on the basis of the Chinese medicine group for 12 consecutive weeks. Gastric mucosa atrophy in the three groups was observed before and after treatment. The gastric mucosal pathological score was evaluated. The Patient Reported Outcome (PRO) scale was used to evaluate the patients′ physical and mental health status and quality of life.An enzyme-linked immunosorbent assay was used to detect serum tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-4, IL-10, IL-37, and transforming growth factor (TGF)-β levels in each group. Real-time fluorescence PCR was used to detect the relative expression levels of signal transducer and activator of transcription 3 (STAT3) and mammalian target of rapamycin (mTOR) mRNA in each group. Western blotting was used to detect the relative expression levels of proteins related to the STAT3/mTOR signaling pathway, and the adverse drug reactions and events were recorded and compared. Results: There was no statistical difference in age, gender, disease duration, family history of gastrointestinal tumors, alcohol consumption history, and body mass index among the three groups of patients.The total therapeutic efficacy rates of the control, Chinese medicine, and combined groups in treating gastric mucosal atrophy were 66.67% (20/30), 86.67% (26/30), and 90.00% (27/30), respectively (P<0.05). Compared to before treatment, the pathological and PRO scale scores of gastric mucosa in each group decreased after treatment, and TNF-α, IL-1β, IL-37, and TGF-β levels decreased. The relative STAT3 and mTOR mRNA expression levels, as well as the relative STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels decreased (P<0.05), whereas the IL-4 and IL-10 levels increased (P<0.05). After treatment, compared to the control group, the pathological score of gastric mucosa, PRO scale score, TNF-α, IL-1β, IL-37, TGF-β content, relative STAT3 and mTOR mRNA expression levels, and relative STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels in the Chinese medicine and combined groups after treatment were reduced (P<0.05), whereas the IL-4 and IL-10 levels increased (P<0.05). After treatment, compared to the Chinese medicine group, the combined group showed a decrease in relative STAT3, mTOR mRNA expression levels, and STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels (P<0.05). Conclusion The combination of PPP and moxibustion may regulate the inflammatory mechanism of the body by inhibiting the abnormal activation of the STAT3/mTOR signaling pathway, upregulating related anti-inflammatory factor levels, downregulating pro-inflammatory factor expression, and increasing related repair factor expression, thereby promoting the recovery of atrophic gastric mucosa, reducing discomfort symptoms, and improving the physical and mental state of CAG patients with spleen and stomach weakness syndrome.

OBJECTIVE: To explore clinical efficacy of percutaneous endoscopic discectomy with a lateral approach and dual-channel method in treating highly free lumbar disc herniation(LDH). METHODS: A retrospective analysis was conducted on 54 patients with highly free LDH who were treated with spinal endoscopic techniques from January 2021 to December 2022. Twenty-seven patients were treated with lateral approach dual-channel(lateral approach dual-channel group), including 16 males and 11 females, with an average age of (54.6±10.5) years old. Twenty-seven patients were treated with unilateral biportal endoscopic (UBE group), including 17 males and 10 females, with an average age of (52.9±12.3) years old. The number of intraoperative fluoroscopy, operation time and hospital stay, as well as visual analogue scale (VAS) and Oswestry diability index (ODI) of low back and leg pain between two patients before operation, 1 day, 1, 3, and 12 months after operation, and the efficacy was evaluated by the modified MacNab criteria at 12 mohths after operation. RESULTS: All patients were successfully completed surgical and were followed up, the time raged from 12 to 22 months with an average of (13.57±4.12) months. There was no statistically significant difference in operation time between two groups (P>0.05). The hospital stay of lateral approach dual-channel group was (3.9±1.1) days, which was shorter than that of UBE group (6.5±1.4) days, the number of intraoperative fluoroscopy in lateral approach dual-channel group was (12.7±2.1) times, which was more than that in UBE group (6.6±1.3) times, the differences were statistically significant (t=5.197, -7.532;P<0.05). VAS and ODI for low back pain at 1 day and 1 month after operation, and VAS for leg pain at 1 day after operation of lateral approach dual-channel group were superior to those of UBE group, and the differences were statistically significant (P<0.05). However, there were no statistically significant differences in VAS and ODI for low back and leg pain between two groups before operation and 3 and 12 months after operation (P>0.05). VAS and ODI of low back and leg pain were significantly improved at each time point before and after operation in both groups, and the difference were statistically significant (P<0.05). At 12 months after operation, according to the modified MacNab criteria, the excellent and good rates of therapeutic effects between lateral approach dual-channel group and UBE group were 92.6% (25/27) and 88.9% (24/27), respectively, and the difference was not statistically significant (χ²=0.22, P>0.05). CONCLUSION For patients with highly free lumbar intervertebral disc protrusion, both of lateral approach dual-channel method and UBE endoscopic surgery are safe and effective. Endoscopic surgery with lateral approach and dual-channel method could be performed under local anesthesia, allowing for the removal of the nucleus pulposus under direct vision. It is simpler, more efficient.
Humans ; Male ; Female ; Intervertebral Disc Displacement/surgery* ; Middle Aged ; Diskectomy, Percutaneous/methods* ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Adult ; Retrospective Studies ; Aged

OBJECTIVE: To investigate the effectiveness of Xuanshen Yishen Decoction (XYD) in the treatment of hypertension. METHODS: Hospital electronic medical records from 2019-2023 were utilized to emulate a randomized pragmatic clinical trial. Hypertensive participants were eligible if they were aged ⩾40 years with baseline systolic blood pressure (BP) ⩾140 mm Hg. Patients treated with XYD plus antihypertensive regimen were assigned to the treatment group, whereas those who followed only antihypertensive regimen were assigned to the control group. The primary outcome assessed was the attainment rate of intensive BP control at discharge, with the secondary outcome focusing on the 6-month all-cause readmission rate. RESULTS: The study included 3,302 patients, comprising 2,943 individuals in the control group and 359 in the treatment group. Compared with the control group, a higher proportion in the treatment group achieved the target BP for intensive BP control [8.09% vs. 17.5%; odds ratio (OR)=2.29, 95% confidence interval (CI)=1.68 to 3.13; P<0.001], particularly in individuals with high homocysteine levels (OR=3.13; 95% CI=1.72 to 5.71; P<0.001; P for interaction=0.041). Furthermore, the 6-month all-cause readmission rate in the treatment group was lower than in the control group (hazard ratio=0.58; 95% CI=0.36 to 0.91; P=0.019), and the robustness of the results was confirmed by sensitivity analyse. CONCLUSIONS XYD could be a complementary therapy for intensive BP control. Our study offers real-world evidence and guides the choice of complementary and alternative therapies. (Registration No. ChiCTR2400086589).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Antihypertensive Agents/pharmacology* ; Blood Pressure/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Hypertension/physiopathology* ; Patient Readmission ; Treatment Outcome

Insulin is an important protein hormone that participates in multiple metabolic pathways.Biosynthetic insulin has been widely used in the treatment of type 1 and type 2 diabetes.Currently,the number of reported cases of insulin overdose both at home and abroad is gradually increasing,and insulin homicide is no longer a means of"committing murder without leaving a trace".At present,there are no systematic protocols for the identification of insulin overdose in the field of forensic medi-cine in China.This article introduces the causes,toxicological characteristics,forensic examination,labo-ratory testing methods and indicator reference of insulin overdose.Based on the identification practice and research results and referring to relevant studies on insulin overdose at home and abroad,this pa-per aims to provide recommendations and references for the formulation of forensic identification guide-lines for insulin overdose cases.

Objective This study was to explore factors related to early radial artery occlusion(RAO)associated transradial approach(TRA).Methods Patients who underwent the TRA from July 2021 to Jan 2024 were included in our study.Patients were divided into radial artery occlusion group and non-radial artery occlusion group.The data of general demography,the number of radial artery punctures attempts,and whether add heparin to the Antispasmodic Agents were recorded to assess the incidence and predictors of RAO.Results A total of 543 patients were included in the study.All patients underwent ultrasound evaluation 24h after DSA.Among them,32 cases experienced RAO,while 511 cases did not experienced RAO.The occurrence rate of RAO was significantly higher in patients without addition of heparin to the antispasmodic agents for the prevention of radial artery spasm,those with more than 3 radial artery puncture attempts and those using either an 11 cm short sheath,or Cordis puncture needles(all P<0.05).Multiple logistic analysis showed that addition of heparin to the Antispasmodic Agents(OR=0.076,95% CI:0.018～0.321,P<0.001),less than 3 radial artery puncture attempts(OR=0.245,95% CI:0.111～0.541,P<0.001),using an 16 cm longer sheath(OR=0.195,95% CI:0.067～0.564,P=0.003),using an Terumo puncture needles(OR=0.325,95% CI:0.148～0.717,P=0.005)could reduce the incidence of RAO.Conclusions Anticoagulation with intrathecal heparin,application of trocar to improve the success rate of puncture,and the use of a 16 cm long sheath can significantly reduce the incidence of early RAO after DSA.

Objective To investigate the safety and feasibility of repeated recanalization of radial artery occlusion(RAO)in neurointerventional therapy.Methods The clinical data,including general information,surgery,ultrasonography,and surgery-related complications,of 18 patients with cerebrovascular diseases,who developed RAO after receiving transradial access(TRA)intervention at the Xiamen Branch of Affiliated Zhongshan Hospital of Fudan University of China between June 2022 and July 2023,were retrospectively analyzed.Results Of 18 patients,7 received two consecutive same-side TRA procedures and 11 received three consecutive same-side TRA procedures.RAO occurred in all patients after the initial cerebrovascular angiography,and subsequent neurointerventional treatment was successfully accomplished after RAO recanalization.The cerebrovascular diseases included arteriovenous malformations(n=3),arterial aneurysm(n=13),and arterial occlusion(n=2).A total of 29 times of puncturing at the site of RAO thrombus were carried out,including 23 times of successful recanalization(success rate being 79.3％).At(8.8±8.7)days after the first-time RAO recanalization,ultrasonography indicated that successful recanalization was obtained in 14 patients and persistent occlusion was seen in 4 patients.Thirteen patients were followed up for(7.8±2.7)months after the initial RAO recanalization,and the ultrasonography revealed that successful recanalization was obtained in 4 patients and persistent occlusion was seen in 9 patients.No severe complications occurred during the follow-up period.Conclusion In situ puncture of the RAO site after its recanalization to perform neurointerventional treatments is clinically safe and feasible.

Objective To explore the clinical efficacy and safety of one-stage posterior lesion removal and internal spinal fixation in patients with lumbar Brucellosis spondylitis.Methods The clinical data of 24 patients admitted from October 2017 to October 2022 were retrospectively analyzed,2 patients were lost to follow-up at 10 months after surgery,at the final 22 cases were included in the study,including 13 males and 9 females with an average age of(52.00±6.89)years old,were treated with one-stage posterior lesion removal and internal spinal fixation.The operation time,intraoperative bleeding,follow-up time,ery-throcyte sedimentation rate(ESR)and C-reactive protein(CRP)before and after operation were recorded.The pain visual ana-logue scale(VAS),Oswestry disability index(ODI),the Japanese Orthopaedic Association(JOA)score for neurofunction,American Spinal Injury Association(ASIA)spinal cord injury grade and modified MacNab criteria were ussed to evaluate the efficacy.Results All patients were followed up from 12 to 30 months with an average of(17.41±4.45)months.The operation time was 70 to 155 min with an average of(1 16.59±24.32)min;the intraoperative bleeding volume was 120 to 520 ml with an average of(275.00±97.53)ml.CRP and ESR levels decreased more significantly at 1 week and at the final follow-up than pre-operative levels(P＜0.05).VAS,JOA score and ODI at 1 week and at the latest follow-up were more significantly improved than preoperative results(P＜0.05).There was no significant difference between ASIA preoperative and 1 week after operation(P＞0.05),and a significant difference between preoperative and last follow-up(P＜0.05).In the final follow-up,21 patients had ex-cellent efficacy,1 patient had fair,and there was no recurrence during the follow-up.Conclusion One-stage transpedicular le-sion removal and internal spinal fixation,with few incisions and short operation time,helps the recovery of neurological func-tion,and the prognosis meets the clinical requirements,which can effectively control Brucella spondylitis.

As artificial intelligence technology rapidly advances, its deployment within the medical sector presents substantial ethical challenges. Consequently, it becomes crucial to create a standardized, transparent, and secure framework for processing medical data. This includes setting the ethical boundaries for medical artificial intelligence and safeguarding both patient rights and data integrity. This consensus governs every facet of medical data handling through artificial intelligence, encompassing data gathering, processing, storage, transmission, utilization, and sharing. Its purpose is to ensure the management of medical data adheres to ethical standards and legal requirements, while safeguarding patient privacy and data security. Concurrently, the principles of compliance with the law, patient privacy respect, patient interest protection, and safety and reliability are underscored. Key issues such as informed consent, data usage, intellectual property protection, conflict of interest, and benefit sharing are examined in depth. The enactment of this expert consensus is intended to foster the profound integration and sustainable advancement of artificial intelligence within the medical domain, while simultaneously ensuring that artificial intelligence adheres strictly to the relevant ethical norms and legal frameworks during the processing of medical data.
Artificial Intelligence/legislation & jurisprudence* ; Humans ; Consensus ; Computer Security/standards* ; Confidentiality/ethics* ; Informed Consent/ethics*

Objective To investigate the safety and feasibility of performing neurointerventional diagnosis and treatment via left distal transradial access(dTRA)or via left transradial access(TRA).Methods The clinical data of patients,who received selective cerebral angiography or neurointerventional treatment using right/left dTRA/TRA at the Fudan Zhongshan Xiamen Branch Hospital of China between January 2022 and December 2023,were retrospectively analyzed.The clinical data including the basic information(including age,gender,diseases,etc.)and the clinical records(including operation mode,operative approach,X-ray fluoroscopy time,puncture-related complications,etc.)were collected.Results A total of 32 patients,who underwent neurointerventional treatment by using left dTRA/TRA approach(left-side group),were enrolled in this study.Among them 11 patients received selective cerebral angiography and 21 patients(having left-sided vertebrobasilar artery disease)received neurointerventional treatment.Other 49 patients,who underwent neurointerventional treatment by using right dTRA/TRA approach(right-side group)during the same period were also included in this study.Among them 19 patients received selective cerebral angiography and 30 patients(having right-sided vertebrobasilar artery disease)received neurointerventional treatment.Angiography reexamination was performed in the patients who had previously received treatment and all of them suffered from endovascular diseases of the anterior circulation system.All angiography and neurointerventional procedures were successfully accomplished with no occurrence of serious complications.In left-side group,4 patients changed to adopt TRA approach to complete the neurointerventional treatment,2 patients changed to adopt TFA approach to complete the neurointerventional treatment,and one patient changed to adopt TFA approach to complete the procedure due to vascular tortuosity of left dTRA.In patients receiving angiography,4 patients changed to adopt left TRA approach and 3 patients failed to complete the elective right subclavian artery catheterization.In patients receiving neurointerventional treatment,2 patients developed postoperative local bruising at the distal radial artery puncture point.Postoperative color ultrasound reexamination showed that there was no radial artery occlusion in all patients receiving angiography or neurointerventional treatment.In right-side group,among the patients receiving neurointerventional treatment,4 patients changed to adopt right TRA approach and 2 patients changed to adopt right TFA;among the patients receiving angiography,4 patients changed to adopt right TRA approach,and bilateral common carotid arteries and bilateral subclavian arteries catheterization were successfully accomplished in all patients;3 patients developed postoperative local bruising at the distal radial artery puncture point.Postoperative color ultrasound reexamination showed that there was no radial artery occlusion in all patients receiving angiography or neurointerventional treatment.No statistically significant differences in the success rate of distal radial artery puncture,intraoperative X-ray fluoroscopy time,catheterization success rate of 4 main vessels(including right common carotid artery,left common carotid artery,right subclavian artery and left subclavian artery),and incidence of postoperative puncture point complications existed between the two groups(all P＞0.05).Conclusion It is clinically safe and feasible to adopt left dTRA/TRA approach for performing selective cerebral angiography and neurointerventional treatment.

To study the chemical constituents from the stems and leaves of Humulus scandens, this study isolated thirteen compounds by different chromatographic methods including silica gel column, ODS, Sephadex LH-20 and preparative HPLC. Based on comprehensive analysis, the chemical structures were elucidated and identified as citrunohin A(1), chrysosplenetin(2), casticin(3), neoechinulin A(4), ethyl 1H-indole-3-carboxylate(5), 3-hydroxyacetyl-indole(6),(1H-indol-3-yl) oxoacetamide(7), inonotusic acid(8), arteannuin B(9), xanthotoxol(10), α-tocopherol quinone(11), eicosanyl-trans-p-coumarate(12), and 9-oxo-(10E,12E)-octadecadienoic acid(13). Among them, compound 1 was a new dihydrochalcone, and the other compounds were obtained from H. scandens for the first time.
Humulus ; Chalcones ; Indoles ; Drugs, Chinese Herbal/chemistry*