Objective To investigate the relationship between pre-liver transplantation plasma soluble programmed cell death protein 1 (sPD-1) levels and prognosis in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICI). Methods A total of 38 HCC liver transplant recipients who received ICI treatment at Beijing Tsinghua Changgung Hospital from January 2021 to February 2024 were included in the study. The use of ICI drugs was reviewed, and the clinical and pathological characteristics of patients with and without postoperative HCC recurrence were compared. Kaplan-Meier analysis was used to evaluate postoperative survival. Pre-transplant plasma samples were collected from patients treated with ICI, and the sPD-1 levels were measured using enzyme-linked immunosorbent assay. Receiver operating characteristic curves were plotted to explore the relationship between sPD-1 expression and clinical pathological features and to analyze the prognosis. The effects of different preoperative ICI discontinuation times on sPD-1 expression were also compared. Results Among the patients, 28 (74%) received anti-programmed cell death protein 1 (PD-1) monoclonal antibodies, 9 (24%) received anti-programmed cell death protein ligand 1 (PD-L1) monoclonal antibodies, and 1 (3%) received bispecific antibodies. Patients were grouped based on whether they had HCC recurrence within 1 year after surgery. Significant differences were found between the two groups in preoperative alpha-fetoprotein levels, tumor number, maximum tumor diameter, capsular invasion, differentiation grade, Ki67 index, conform to Milan criteria, conform to University of California at San Francisco (UCSF) criteria and tumor, node, metastasis (TNM) staging (all P<0.05). The median pre-transplant plasma sPD-1 level was 902 (318, 4 406) pg/mL, and the sPD-1 level was higher in the recurrence group than in the non-recurrence group (P<0.05). Using 2 073 pg/mL as the cut-off value, patients were divided into high and low sPD-1 level groups. Significant differences were found between the two groups in tumor number, postoperative hospital stay and total hospital stay (all P<0.05). Kaplan-Meier analysis showed that the disease-free survival rate was lower in the high sPD-1 level group than in the low sPD-1 level group (P=0.004), while the overall survival rate did not differ significantly between the two groups (P=0.381). In addition, patients who discontinued ICI treatment ≤ 5 half-lives before surgery had higher sPD-1 levels than those who discontinued ICI treatment for >5 half-lives before surgery. Conclusions Pre-transplant plasma sPD-1 levels are closely related to prognosis and may reflect the dynamic changes in the immune microenvironment. For patients with high pre-transplant plasma sPD-1 levels, the indications for liver transplantation should be carefully evaluated, and postoperative management and follow-up should be strengthened. Early intervention should be provided to improve patients' quality of life and prolong their survival.

OBJECTIVE: To explore the protective effect of bloodletting acupuncture at twelve Jing-well points on hand (BAJP) on acute hypobaric hypoxia (AHH)-induced brain injury in rats and its possible mechanisms. METHODS: Seventy-five Sprague Dawley rats were divided into 5 groups by a random number table (n=15), including control, model, BAJP, BAJP+3-methyladenine (3-MA), and bloodletting acupuncture at non-acupoint (BANA, tail tip blooding) groups. After 7-day pre-treatment, AHH models were established using hypobaric oxygen chambers. The levels of S100B, glial fibrillary acidic protein (GFAP), superoxide dismutase (SOD), and malondialdehyde (MDA) in serum were measured by enzyme-linked immunosorbent assay. Hematoxylin-eosin staining and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling method were used to assess hippocampal histopathology and apoptosis. Transmission electron microscopy assay was used to observe mitochondrial damage and autophagosomes in hippocampal tissues. Flow cytometry was used to detect mitochondrial membrane potential (MMP). The mitochondrial respiratory chain complexes I, III and IV activities and ATPase in hippocampal tissue were evaluated, respectively. Western blot analysis was used to detect the protein expressions of Beclin1, autophagy protein 5 (ATG5), microtubule-associated protein 1 light chain 3 beta (LC3B), phosphatase and tensin homolog induced kinase 1 (PINK1), and Parkin in hippocampal tissues. The mRNA expressions of Beclin1, ATG5 and LC3-II were analyzed by quantitative real-time polymerase chain reaction. RESULTS: BAJP treatment reduced hippocampal tissue injury and inhibited hippocampal cell apoptosis in AHH rats. BAJP reduced oxidative stress by decreasing S100B, GFAP and MDA levels and increasing SOD level in the serum of AHH rats (P<0.05 or P<0.01). Then, BAJP increased MMP, the mitochondrial respiratory chain complexes I, III and IV activities, and the mitochondrial ATPase activity in AHH rats (all P<0.01). BAJP improved mitochondrial swelling and increased the autophagosome number in hippocampal tissue of AHH rats. Moreover, BAJP treatment increased the protein and mRNA expressions of Beclin1 and ATG5 and LC3-II/LC3-I ratio in AHH rats (all P<0.01) and activated the PINK1/Parkin pathway (P<0.01). Finally, 3-MA attenuated the therapeutic effect of BAJP on AHH rats (P<0.05 or P<0.01). CONCLUSION BAJP was an effective treatment for AHH-induced brain injury, and the mechanism might be through reducing hippocampal tissue injury via increasing the PINK1/Parkin pathway and enhancement of mitochondrial autophagy.

OBJECTIVE: To explore the protective effect and possible mechanisms of bloodletting acupuncture at Jing-well points (BAJP) pre-treatment on acute hypobaric hypoxia (AHH)-induced myocardium injury rat. METHODS: Seventy-five rats were randomly divided into 5 groups by a random number table: a control group (n=15), a model group (n=15), a BAJP group (n=15), a BAJP+3-methyladenine (3-MA) group (n=15), and a BANA (bloodletting at nonacupoint; tail bleeding, n=15) group. Except for the control group, the AHH rat model was established in the other groups, and the corresponding treatment methods were adopted. Enzyme-linked immunosorbent assay (ELISA) was used to detect creatine kinase isoenzyme MB (CK-MB) and cardiac troponins I (CTnI) levels in serum and superoxide dismutase (SOD) and malondialdehyde (MDA) levels in myocardial tissue. Hematoxylin-eosin (HE) staining was used to observe myocardial injury, and terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) staining was used to observe cell apoptosis. Transmission electron microscopy detection was used to observe mitochondrial damage and autophagosomes in the myocardium. The mitochondrial membrane potential of the myocardium was analyzed with the fluorescent dye JC-1. Mitochondrial respiratory chain complex (complex I, III, and IV) activities and ATPase in the myocardium were detected by mitochondrial respiratory chain complex assay kits. Western blot analysis was used to detect the autophagy index and hypoxia inducible factor-1α (HIF-1α)/Bcl-2 and adenovirus E1B 19k Da-interacting protein 3 (BNIP3) signaling. RESULTS: BAJP reduced myocardial injury and inhibited myocardial cell apoptosis in AHH rats. BAJP pretreatment decreased MDA levels and increased SOD levels in AHH rats (all P<0.01). Moreover, BAJP pretreatment increased the mitochondrial membrane potential (P<0.01), mitochondrial respiratory chain complex (complexes I, III, and IV) activities (P<0.01), and mitochondrial ATPase activity in AHH rats (P<0.05). The results from electron microscopy demonstrated that BAJP pretreatment improved mitochondrial swelling and increased the autophagosome number in the myocardium of AHH rats. In addition, BAJP pretreatment activated the HIF-1α/BNIP3 pathway and autophagy. Finally, the results of using 3-MA to inhibit autophagy in BAJP-treated AHH rats showed that suppression of autophagy attenuated the treatment effects of BAJP in AHH rats, further proving that autophagy constitutes a potential target for BAJP treatment of AHH. CONCLUSION BAJP is an effective treatment for AHH-induced myocardial injury, and the mechanism might involve increasing HIF-1α/BNIP3 signaling-mediated autophagy and decreasing oxidative stress.
Animals ; Rats ; Acupuncture Therapy ; Altitude ; Apoptosis ; Autophagy ; Bloodletting ; Hypoxia/metabolism* ; Membrane Proteins/pharmacology* ; Mitochondrial Proteins/pharmacology* ; Oxidative Stress ; Rats, Sprague-Dawley

Quantity is the key factor to ensure the safety and effectiveness of medicines. It is very important to study and determine the traditional measuring units and their quantity values of Tibetan medicine. Based on the literature records of Tibetan medicine and combined with modern experimental verification and investigation research, this study determined the reference, name, and conversion rate of traditional measuring units of Tibetan medicine. Meanwhile, through large sample sampling and repeated quantification of refe-rence of basic units, its weight and volume were clarified. The modern SI volume and weight unit values corresponding to the traditional volume and weight units of Tibetan medicine were deduced, and the correctness, reliability, and practicability of these determination results were demonstrated. This study also put forward some specific suggestions and reference values for formulating the standards of measuring units of weight and volume of Tibetan medicine. It is of great significance in guiding the processing, production, and clinical treatment of Tibetan medicine, and promoting the standardization and standardized development of Tibetan medicine.
Medicine, Tibetan Traditional ; Reproducibility of Results

Objective: To examine the clinical efficacy of 3 anti-reflux methods of digestive tract reconstruction after proximal gastrectomy for gastric cancer. Methods: The clinical data and follow-up data of gastric cancer patients who underwent anti-reflux reconstruction after proximal gastrectomy in 11 medical centers of China from September 2016 to August 2021 were retrospectively collected, including 273 males and 65 females, aging of (63±10) years (range: 28 to 91 years). Among them, 159 cases were performed with gastric tube anastomosis (GTA), 107 cases with double tract reconstruction (DTR), and 72 cases with double-flap technique (DFT), respectively. The duration of operation, length of postoperative hospital stay and early postoperative complications (referring to Clavien-Dindo classification) of different anti-reflux reconstruction methods were assessed. Body mass index, hemoglobin and albumin were used to reflect postoperative nutritional status. Reflux esophagitis was graded according to Los Angeles criteria based on the routinely gastroscopy within 12 months after surgery. The postoperative quality of life (QoL) was evaluated by Visick score system. The ANOVA analysis, Kruskal-Wallis rank sum test, χ² test and Fisher's exact test were used for comparison between multiple groups, and further comparison among groups were performed with LSD, Tamhane's test or Bonferroni corrected χ² test. The mixed effect model was used to compare the trends of Body mass index, hemoglobin and albumin over time among different groups. Results: The operation time of DFT was significantly longer than that of GTA and DTR ((352±63) minutes vs. (221±66) minutes, (352±63) minutes vs. (234±61) minutes, both P<0.01). The incidence of early complications with Clavien-Dindo grade Ⅱ to Ⅴ in GTA, DFT and DTR groups was 17.0% (27/159), 9.7% (7/72) and 10.3% (11/107), respectively, without significant difference among these three groups (χ²=3.51, P=0.173). Body mass index decreased more significantly in GTA than DFT group at 6 and 12 months after surgery (mean difference=1.721 kg/m², P<0.01; mean difference=2.429 kg/m², P<0.01). body mass index decreased significantly in DTR compared with DFT at 12 months after surgery (mean difference=1.319 kg/m², P=0.027). There was no significant difference in hemoglobin or albumin fluctuation between different reconstruction methods perioperative. The incidence of reflux esophagitis one year after surgery in DTR group was 12.9% (4/31), which was lower than that in DFT (45.9% (17/37), χ²=8.63, P=0.003). Follow-up of postoperative quality of life showed the incidence of Visick grade 2 to 4 in DFT group was lower than that in GTA group (10.4% (7/67) vs. 34.6% (27/78), χ²=11.70, P=0.018), while there was no significant difference between DFT and DTR group (10.4% (7/67) vs. 22.2% (8/36, P>0.05). Conclusions: Compared with GTA and DTR, DFT is more time-consuming, but there is no significant difference in early complications among three methods. DFT reconstruction is more conducive to maintain postoperative nutritional status and improve QoL, especially compared with GTA. The risk of reflux esophagitis after DTR reconstruction is lower than that of DFT.
Aged ; Albumins ; Esophagitis, Peptic/surgery* ; Female ; Gastrectomy/methods* ; Hemoglobins ; Humans ; Male ; Middle Aged ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms/surgery*

Objective:To study the clinical effect of vacuum sealing drainage in the treatment of chronic traumatic subcutaneous hematoma.Methods:Patients of chronic traumatic subcutaneous hematoma who were admitted to the Department of Burns and Plastic Surgery of Jiaozhou Central Hospital of Qingdao from June 2018 to June 2021 were included and randomly divided into the control group and the experimental group according to the random number table method. The subcutaneous hematoma was incised for debridement, and the blood clots, exudates, necrotic tissues, and pseudosynovium in the cavity were removed. The control group was treated with vaseline oil gauze filling drainage and dressing change method, and the experimental group was treated with vacuum sealing drainage and dressing change method. During the treatment, the closing time of subcutaneous hematoma cavity was observed and compared between the two groups.Results:A total of 42 patients with chronic traumatic subcutaneous hematoma were enrolled, 21 in the control group and 21 in the experimental group, including 11 males and 10 females in the control group, aged (46.2±12.4) years; 13 males and 8 females in the experimental group, aged (44.3±10.6) years. After treatment, all the subcutaneous hematoma spaces were closed in the 42 patients. The closing time of subcutaneous hematoma cavity in the experimental group was (15.52±1.69) days, which was significantly shorter than that in the control group (24.14±2.57) days. There was a significant difference between the two groups ( P<0.01). Conclusions:After incision and debridement of chronic traumatic subcutaneous hematoma, vacuum sealing drainage and dressing change can actively and fully drain the exudate in the cavity, residual blood clots, necrotic tissues, and pseudosynovium, promote the growth of new granulation tissue, which is more conducive to the closure of the cavity of subcutaneous hematoma, and shorten the clinical treatment cycle.

Objective:To study the clinical effect of vacuum sealing drainage in the treatment of chronic traumatic subcutaneous hematoma.Methods:Patients of chronic traumatic subcutaneous hematoma who were admitted to the Department of Burns and Plastic Surgery of Jiaozhou Central Hospital of Qingdao from June 2018 to June 2021 were included and randomly divided into the control group and the experimental group according to the random number table method. The subcutaneous hematoma was incised for debridement, and the blood clots, exudates, necrotic tissues, and pseudosynovium in the cavity were removed. The control group was treated with vaseline oil gauze filling drainage and dressing change method, and the experimental group was treated with vacuum sealing drainage and dressing change method. During the treatment, the closing time of subcutaneous hematoma cavity was observed and compared between the two groups.Results:A total of 42 patients with chronic traumatic subcutaneous hematoma were enrolled, 21 in the control group and 21 in the experimental group, including 11 males and 10 females in the control group, aged (46.2±12.4) years; 13 males and 8 females in the experimental group, aged (44.3±10.6) years. After treatment, all the subcutaneous hematoma spaces were closed in the 42 patients. The closing time of subcutaneous hematoma cavity in the experimental group was (15.52±1.69) days, which was significantly shorter than that in the control group (24.14±2.57) days. There was a significant difference between the two groups ( P<0.01). Conclusions:After incision and debridement of chronic traumatic subcutaneous hematoma, vacuum sealing drainage and dressing change can actively and fully drain the exudate in the cavity, residual blood clots, necrotic tissues, and pseudosynovium, promote the growth of new granulation tissue, which is more conducive to the closure of the cavity of subcutaneous hematoma, and shorten the clinical treatment cycle.

Objective:To explore the clinical application of vacuum sealing drainage (VSD) in the treatment of skin abscess caused by methicillin-resistant staphylococcus aureus (MRSA) infection. Methods:From January 2017 to December 2019, patients with skin abscess caused by MRSA admitted to the Department of Burns and Plastic Surgery of Qingdao Jiaozhou Central Hospital were selected. The patients were randomly divided into control group and experimental group according to the random number table method. Control group was treated with vaseline gauze packing, drainage and dressing change. Experimental group was treated with VSD and dressing change. During the treatment, the lacunar closure of skin abscess in the two groups was observed comparatively, pus bacteria culture and antibiotic sensitivity test were conducted regularly to observe the wound infection control situation.Results:A total of 68 patients with skin abscess caused by MRSA were enrolled, including 43 males and 25 females, the average age was 47.66±15.71 years old. There were 20 males and 14 females in the control group(mean age 46.96±16.23 years old), 23 males and 11 females in the experimental group(mean age 48.35±15.18 years old). The healing time of skin abscess lacuna in control group was (27.79±1.97) d, (15.74±1.31) din experimental group. Bacterial culture of pus and drug sensitivity test detect the growth time from MRSA to non-pathogenic bacteria in control group was (18.65±1.47) d, (9.76±1.28) din experimental group. The difference between the two groups was statistically significant ( P<0.05). Conclusions:After incision and debridement, VSD and drainageand dressing change may serve as an alternative option for the skin abscess infected by MRSA. By actively and fully draining pus, the microenvironment of pathogenic bacteria reproduction and growth is changed, and the growth of fresh granulation tissue in the lacuna is promoted, the infection of MRSA can be more effectively controlled, the lacuna closure of skin abscess is promoted, and the clinical treatment cycle is shortened.

Objective:To explore the clinical application of vacuum sealing drainage (VSD) in the treatment of skin abscess caused by methicillin-resistant staphylococcus aureus (MRSA) infection. Methods:From January 2017 to December 2019, patients with skin abscess caused by MRSA admitted to the Department of Burns and Plastic Surgery of Qingdao Jiaozhou Central Hospital were selected. The patients were randomly divided into control group and experimental group according to the random number table method. Control group was treated with vaseline gauze packing, drainage and dressing change. Experimental group was treated with VSD and dressing change. During the treatment, the lacunar closure of skin abscess in the two groups was observed comparatively, pus bacteria culture and antibiotic sensitivity test were conducted regularly to observe the wound infection control situation.Results:A total of 68 patients with skin abscess caused by MRSA were enrolled, including 43 males and 25 females, the average age was 47.66±15.71 years old. There were 20 males and 14 females in the control group(mean age 46.96±16.23 years old), 23 males and 11 females in the experimental group(mean age 48.35±15.18 years old). The healing time of skin abscess lacuna in control group was (27.79±1.97) d, (15.74±1.31) din experimental group. Bacterial culture of pus and drug sensitivity test detect the growth time from MRSA to non-pathogenic bacteria in control group was (18.65±1.47) d, (9.76±1.28) din experimental group. The difference between the two groups was statistically significant ( P<0.05). Conclusions:After incision and debridement, VSD and drainageand dressing change may serve as an alternative option for the skin abscess infected by MRSA. By actively and fully draining pus, the microenvironment of pathogenic bacteria reproduction and growth is changed, and the growth of fresh granulation tissue in the lacuna is promoted, the infection of MRSA can be more effectively controlled, the lacuna closure of skin abscess is promoted, and the clinical treatment cycle is shortened.

Coptidis Rhizoma-Evodia Fructus is a classic herb pair in traditional Chinese medicine prescriptions, the famous prescription is called Zuojinwan, which comes from Danxi Xinfa, is composed of Coptidis Rhizoma-Evodia Fructus (6∶1). In this formula, Coptidis Rhizoma has the effect of clearing heat and drying diuresis, purging fire to remove toxin and clearing heart. Evodia Fructus has the effects of expelling cold and alleviating pain, checking upward adverse flow of Qi tostop vomiting, and assisting yang to stop diarrhea. Coptidis Rhizoma has the properties of bitter and cold, and Evodia Fructus has the properties of pungent and calidus. Pungent drugs have divergent effects, and bitter drugs have sedimentation effect, when used in combination, they can clear the liver and purge fire, calm the adverse-rising energy and stop vomiting. On the basis of Zuojinwan, Coptidis Rhizoma-Evodia Fructus medicine has derived different compatibility ratios. Different ratios are different in terms of efficacy, usage, clinical application. Although with the application of modern analytical instruments and the development of molecular pharmacology theory, the chemical constituents and Pharmacological effects of Coptidis Rhizoma and Evodia Fructus have been fully studied, as to the principle of compatibility, and the study of pharmacological effects and chemical constituents after the compatibility of the two drugs in different proportions, there is still no comprehensive system summary. This article makes a systematic and comprehensive explanation of Coptidis Rhizoma-Evodia Fructus from the aspects of famous literature, chemical composition, pharmacological effects and clinical applicationthrough querying literature and ancient books. In order to make this herb pair more standardized, and provide reference materials for further research and development for this herb pair.