ObjectiveTo investigate the characteristics and distribution of traditional Chinese medicine （TCM） syndromes in the patients with esophageal squamous cell carcinoma （ESCC）. MethodsAn electronic questionnaire was developed to collect the general data and four examination information of ESCC patients treated in 10 areas with high incidence of esophageal cancer in China from June 2020 to March 2021. Multiple analyses including frequency analysis， factor analysis， and hierarchical cluster analysis were performed to analyze the potential syndrome elements， disease location， and common syndromes of ESCC. ResultsA total of 2 027 patients with ESCC were included. Statistical analysis was performed on 113 symptoms， physical signs， 33 tongue manifestation variables， and 23 pulse manifestation variables of the patients’ four examination information. Factor analysis was performed on 55 variables with frequency>10%， extracting 19 common factors. According to clinical experience and expert opinions， the main lesions of patients with ESCC were in the spleen and stomach， and the main syndrome elements were Qi stagnation， blood stasis， phlegm， dampness， and Qi deficiency， with the syndrome element combination of phlegm obstruction + Qi stagnation + blood stasis being the most common. The syndromes can be classified into four categories of liver-stomach disharmony + combined phlegm and Qi obstruction， kidney-spleen dysfunction + combined phlegm and stasis， spleen-kidney Yang deficiency + obstinate phlegm and blood stasis， and liver-kidney Yin deficiency + obstinate phlegm and blood stasis. The main syndrome of ESCC was liver-stomach disharmony + combined phlegm and Qi obstruction in the early stage， liver-spleen dysfunction + combined phlegm and stasis in the middle stage， and spleen-kidney Yang deficiency + obstinate phlegm and blood stasis in the late stage. ConclusionESCC mainly has main pathological features of internal deficiency and external excess and combined deficiency and excess， with the key syndrome elements being phlegm obstruction， Qi stagnation， and blood stasis. The main disease locations are in the spleen and stomach， involving the liver， kidney， chest and diaphragm， heart， and lung. The main syndrome is liver-stomach disharmony + combined phlegm and Qi obstruction. In clinical practice， it is necessary to grasp the pathogenesis dynamics of the disease and use prescriptions according to patients’ syndromes.

Objective:To investigate the efficacy and safety of off-label use of flow diverters (FDs) in aneurysms beyond the circle of Willis.Methods:Seventy-one patients with aneurysms beyond the circle of Willis treated with FDs from January 2016 to September 2023 at Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital of Southern Medical University), Department of Neurosurgery (Guangdong Provincial People's Hospital), Department of Neurosurgery (First Affiliated Hospital of Chongqing Medical University), and Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University) were selected. The clinical and imaging data of these patients were analyzed retrospectively, and the clinical characteristics, aneurysm characteristics, endovascular treatments, perioperative complications, and clinical and imaging follow-up results were summarized and analyzed.Results:Among the 71 patients, 22 (31.0%) had ischemic stroke history and 43 (60.6%) had hypertension history. A total of 76 aneurysms were found, including 5 aneurysms (6.6%) at the anterior communicating artery, 10 (13.2%) at the anterior cerebral artery, 53 (69.7%) at the middle cerebral artery, and 8 (10.5%) at the posterior cerebral artery. The median aneurysm size (Inter Quartile Range) was 5.65 (3.63, 10.12) mm, and mean diameter of the parent artery was (2.70±0.57) mm. A total of 80 FDs were used, including 38 (47.5%) Pipeline embolization devices and 42 (52.5%) Tubridge embolization devices; the implantation success rate was 98.8% (79/80). Seven patients (9.9%) had perioperative complications, of which 2 (2.8%) were permanent (1 patient with visual field defect and 1 patient with intracranial hemorrhage). Seventy-one patients had clinical follow-up for (19.73±11.90) months, of which 68 patients (95.8%) had good outcome (modified Rankin scale score of 0-2), 10 patients (14.1%) had ischemic complications, and one patient (1.4%) had hemorrhage complications. Sixty-seven aneurysms (88.2%) underwent angiographic follow-up for 7 (6-12) months, of which 44 aneurysms (65.7%) were completely occluded and 10 (14.9%) had in-stent stenosis.Conclusion:The results of this study preliminarily confirm that off-label use of FDs is relatively safe and effective in aneurysms beyond the circle of Willis.

Objective:To explore the efficacy and safety of embolization of anterior cranial fossa dural arteriovenous fistula (ACF-DAVF) via different arterial approaches, and provide evidence for individualized treatment of ACF-DAVF. Methods:A retrospective study was performed; 25 patients with ACF-DAVF admitted to Department of Cerebrovascular Surgery, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from January 2020 to December 2023 were enrolled. Vascular approaches, including the anterior cerebral artery ( n=7), facial artery ( n=3), middle meningeal artery ( n=8), ophthalmic artery ( n=6), and vein ( n=1), were selected based on angioarchitectural features and microcatheter accessibility. Fistula and proximal draining vein occlusions were confirmed by immediate post-embolization digital subtraction angiography (DSA), and perioperative complications were recorded. At a 6-month follow-up, prognoses were assessed by modified Rankin Scale (mRS), and DSA or MRA was performed to detect the recurrence of ACF-DAVF. Results:Six patients had complete embolization and 2 patients had near-total embolization of the fistula and proximal draining vein immediately after embolization via middle meningeal artery approach; 4 patients achieved complete embolization and 2 patients achieved near-total embolization via ophthalmic artery approach; 6 patients achieved complete embolization and one patient achieved near-total embolization via anterior cerebral artery approach; 3 patients achieved complete embolization via facial artery approach; one patient achieved complete embolization via venous approach. No perioperative intracranial hemorrhage or central retinal artery occlusion was noted. Follow-up for 6 months was performed in 25 patients: mRS score was 0 in 19 patients, 1 in 2 patients, and 2 in 4 patients; DSA in 19 patients and MRA in 6 patients indicated no ACF-DAVF recurrence. Conclusion:Based on the angioarchitectural features and microcatheter accessibility, individualized selection of vascular approaches for ACF-DAVF embolization can achieve better efficacy and safety.

Objective To investigate the role and biological mechanism of exosomal miRNA-141-3p in inducing the proliferation and invasion of prostate cancer(PCa)cells.Methods The expression level of miR-NA-141-3p in tumor tissues and adjacent tissues from 33 PCa patients,as well as in exosomes of human PCa cells VCap and normal prostate cells RWPE-2,was analyzed using quantitative real-time PCR(qPCR).The di-rect target of miRNA-141-3p was predicted through bioinformatic analysis and verified using a dual-luciferase reporter gene assay.miRNA-141-3p inhibitor plasmid(miRNA-141-3p inhibitor group)and negative control plasmid(negative control group)were transfected into human PCa cells VCap via lipofection.Cell prolifera-tion,migration,and invasion abilities in the miRNA-141-3p inhibitor group and negative control group were detected using MTT assay,wound healing assay,and Transwell assay,respectively.The mRNA expression levels of PHLPP2,E-Cadherin,and Vimentin were measured by qPCR,and the protein expression levels by Western blot,in VCap and RWPE-2 cells as well as in the miRNA-141-3p inhibitor group and negative control group.Results The expression level of exosomal miRNA-141-3p in tumor tissues was significantly higher than in adjacent tissues(P<0.05).Dual-luciferase reporter assay confirmed that PHLPP2 is the direct target gene of miRNA-141-3p.The expression levels of exosomal PHLPP2,E-Cadherin mRNA and protein in VCap cells were lower than in RWPE-2 cells,while the expression levels of Vimentin mRNA and protein were high-er than in RWPE-2 cells,with statistically significant intergroup differences(P=0.012).In the miR-141-3p inhibitor group,exosomal miR-141-3p,Vimentin mRNA expression level,cell proliferation rate(MTS assay),migrating cell count(scratch assay),and transmembrane cell count(Transwell invasion assay)were signifi-cantly decreased compared to the negative control group,while PHLPP2 mRNA and E-Cadherin mRNA ex-pression levels were significantly increased,with statistically significant intergroup differences(P<0.05).Conclusion miR-141-3p promotes proliferation and migration of human PCa cells by targeting PHLPP2.

Objective:To investigate the efficacy and safety of off-label use of flow diverters (FDs) in aneurysms beyond the circle of Willis.Methods:Seventy-one patients with aneurysms beyond the circle of Willis treated with FDs from January 2016 to September 2023 at Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital of Southern Medical University), Department of Neurosurgery (Guangdong Provincial People's Hospital), Department of Neurosurgery (First Affiliated Hospital of Chongqing Medical University), and Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University) were selected. The clinical and imaging data of these patients were analyzed retrospectively, and the clinical characteristics, aneurysm characteristics, endovascular treatments, perioperative complications, and clinical and imaging follow-up results were summarized and analyzed.Results:Among the 71 patients, 22 (31.0%) had ischemic stroke history and 43 (60.6%) had hypertension history. A total of 76 aneurysms were found, including 5 aneurysms (6.6%) at the anterior communicating artery, 10 (13.2%) at the anterior cerebral artery, 53 (69.7%) at the middle cerebral artery, and 8 (10.5%) at the posterior cerebral artery. The median aneurysm size (Inter Quartile Range) was 5.65 (3.63, 10.12) mm, and mean diameter of the parent artery was (2.70±0.57) mm. A total of 80 FDs were used, including 38 (47.5%) Pipeline embolization devices and 42 (52.5%) Tubridge embolization devices; the implantation success rate was 98.8% (79/80). Seven patients (9.9%) had perioperative complications, of which 2 (2.8%) were permanent (1 patient with visual field defect and 1 patient with intracranial hemorrhage). Seventy-one patients had clinical follow-up for (19.73±11.90) months, of which 68 patients (95.8%) had good outcome (modified Rankin scale score of 0-2), 10 patients (14.1%) had ischemic complications, and one patient (1.4%) had hemorrhage complications. Sixty-seven aneurysms (88.2%) underwent angiographic follow-up for 7 (6-12) months, of which 44 aneurysms (65.7%) were completely occluded and 10 (14.9%) had in-stent stenosis.Conclusion:The results of this study preliminarily confirm that off-label use of FDs is relatively safe and effective in aneurysms beyond the circle of Willis.

Objective:To explore the efficacy and safety of embolization of anterior cranial fossa dural arteriovenous fistula (ACF-DAVF) via different arterial approaches, and provide evidence for individualized treatment of ACF-DAVF. Methods:A retrospective study was performed; 25 patients with ACF-DAVF admitted to Department of Cerebrovascular Surgery, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from January 2020 to December 2023 were enrolled. Vascular approaches, including the anterior cerebral artery ( n=7), facial artery ( n=3), middle meningeal artery ( n=8), ophthalmic artery ( n=6), and vein ( n=1), were selected based on angioarchitectural features and microcatheter accessibility. Fistula and proximal draining vein occlusions were confirmed by immediate post-embolization digital subtraction angiography (DSA), and perioperative complications were recorded. At a 6-month follow-up, prognoses were assessed by modified Rankin Scale (mRS), and DSA or MRA was performed to detect the recurrence of ACF-DAVF. Results:Six patients had complete embolization and 2 patients had near-total embolization of the fistula and proximal draining vein immediately after embolization via middle meningeal artery approach; 4 patients achieved complete embolization and 2 patients achieved near-total embolization via ophthalmic artery approach; 6 patients achieved complete embolization and one patient achieved near-total embolization via anterior cerebral artery approach; 3 patients achieved complete embolization via facial artery approach; one patient achieved complete embolization via venous approach. No perioperative intracranial hemorrhage or central retinal artery occlusion was noted. Follow-up for 6 months was performed in 25 patients: mRS score was 0 in 19 patients, 1 in 2 patients, and 2 in 4 patients; DSA in 19 patients and MRA in 6 patients indicated no ACF-DAVF recurrence. Conclusion:Based on the angioarchitectural features and microcatheter accessibility, individualized selection of vascular approaches for ACF-DAVF embolization can achieve better efficacy and safety.

Necroptosis is a regulated process of programmed cell death independent of aspartic acid-specific cysteine protease,which can induce inflammation.Studies have shown that necroptosis is closely related to the progression and prognosis of pancreatic disease and plays an important two-way regulatory role in its progression.Related necroptosis inhibitors and inducers are expected to be used in the treatment of pancreatic disease.We herein review the mechanism of necroptosis and its role in the progression of pancreatic disease to provide a new understanding of the pathogenesis and treatment of pancreatic diseases and offer a theoretical basis for the research and development of targeted drugs.

ObjectiveThis study aims to examine the effect of Rhei Radix et Rhizoma-Coptidis Rhizoma on reducing insulin resistance in db/db mice by regulating the adenylate activated protein kinase （AMPK）/UNC-51-like kinase 1 （ULK1）/key molecule of autophagy， benzyl chloride 1 （Beclin1） pathway and elucidate the underlying mechanism. MethodSixty 6-week-old male db/db mice were studied. They were randomly divided into the model group， metformin group （0.26 g·kg^-1）， and low-， middle-， and high-dose groups （2.25， 4.5， 9 g·kg^-1） of Rhei Radix et Rhizoma-Coptidis Rhizoma. A blank group of db/m mice of the same age was set， with 12 mice in each group. After eight weeks of continuous intragastric administration， the blank group and model group received distilled water intragastrically once a day. The survival status of the mice was observed， and fasting blood glucose （FBG） was measured using a Roche blood glucose device. Fasting serum insulin （FINS） was measured using an enzyme-linked immunosorbent assay， and the insulin resistance index （HOMA-IR） was calculated. Hematoxylin-eosin （HE） staining was performed to observe the pathological changes in the liver of the mice. The protein expression levels of AMPK， Beclin1， autophagy associated protein 5 （Atg5）， and p62 in liver tissue were determined by using Western blot. The protein expression levels of autophagy associated protein 1 light chain 3B （LC3B） and ULK1 in liver tissue were determined using immunofluorescence. Real-time fluorescence quantitative PCR （Real-time PCR） was used to measure mRNA expression levels of AMPK， Beclin1， Atg5， ULK1， and p62. ResultCompared with the blank group， the model group exhibited a significant increase in body mass （P<0.01）. Additionally， the levels of FBG， FINS， and HOMA-IR significantly changed （P<0.01）. The structure of liver cells was disordered. The protein expression levels of AMPK， Beclin1， and Atg5 in liver tissue were significantly decreased （P<0.01）， while the expression level of p62 protein was significantly increased （P<0.01）. The expression levels of mRNA and proteins were consistent. Compared with the model group， the body mass of the metformin group and high and medium-dose groups of Rhei Radix et Rhizoma-Coptidis Rhizoma was significantly decreased （P<0.05）. FBG， FINS， and HOMA-IR were significantly decreased （P<0.05，P<0.01）. After treatment， the liver structure damage in each group was alleviated to varying degrees. The protein expressions of AMPK， Beclin1， Atg5， LC3B， and ULK1 were increased （P<0.05，P<0.01）， while the protein expression of p62 was decreased （P<0.01）. The expression levels of mRNA and proteins were generally consistent. ConclusionThe combination of Rhei Radix et Rhizoma-Coptidis Rhizoma can effectively improve liver insulin resistance， regulate the AMPK autophagy signaling pathway， alleviate insulin resistance in db/db mice， and effectively prevent the occurrence and development of type 2 diabetes.

Objective:To explore the value of severe ultrasound measurement of internal jugular vein dilation index (ΔIJV) combined with passive leg raising (PLR) in predicting the volume responsiveness of septic shock.Methods:Patients diagnosed with septic shock under complete mechanical ventilation in the ICU of Jinshan Hospital Affiliated to Fudan University from January 2020 to March 2021 were prospectively selected as the research objects. After 500 mL crystals were injected within 30 min, the patients having the "gold standard" left stroke volume (SV) increased by 15% were allocated to the volume response positive group, and patient having an SV increased by less than 15% to the volume response negative group. First, the maximum anterior posterior diameter (IJV max) and the minimum anterior posterior diameter (IJV min) in the respiratory cycle of internal jugular vein were measured by ultrasound, then SV before and after PLR was measured, and finally SV, IJV max and IJV min were measured again after rapid infusion of 500 mL crystals, and ΔIJV=(IJV max-IJV min)/(IJV mean)×100%. The Wilcoxon rank-sum test was used to compare the hemodynamic indexes before and after capacity expansion and PLR. Spearman rank method was used to analyze the change rate of SV (ΔSV) after PLR and the correlation between ΔIJV and ΔSV of the "gold standard". The sensitivity, specificity and relevant cut-off values were obtained by drawing the subject function curve to evaluate the value of ΔIJV and PLR in predicting the volume responsiveness of patients with sepsis. Results:A total of 56 patients were enrolled in the study, and they were divided into two groups: 32 patients in the volume response positive group and 24 patients in the volume response negative group. There was a positive correlation between ΔIJV and ΔSV after capacity expansion ( r=0.778, P<0.01). Taking ΔIJV>17.3% as the threshold, the area under the curve (AUC) was 0.846 (95% CI: 0.716~0.977), the sensitivity was 84.4% and the specificity was 83.3%. PLR was also positively correlated with ΔSV ( r=0.698, P<0.01). Taking ΔSV>15.5% after PLR as the threshold, the AUC was 0.895 (95% CI: 0.796~0.993), the sensitivity was 96.9%, and the specificity was 79.2%. When ΔIJV combined with PLR predicted volume reactivity, the AUC was 0.944 (95% CI: 0.862~1.000), the sensitivity was 99.8% and the specificity was 87.5%. Conclusions:The measurement of internal jugular vein respiratory dilation index by bedside ultrasound is a reliable index to predict volume responsiveness in patients with sepsis. When combined with PLR, the sensitivity and specificity of prediction can be improved.

Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA)in elderly patients with early-stage lung cancer who were unable to underwent surgery,and to evaluate the risk factors for prognosis.Methods A total of 51 patients with early stage(stages Ⅰ and ⅡA)non-small cell lung cancer (NSCLC)who underwent MWA in Beijing hospital from January 2016 to December 2018 were collected as the MWA group.And 50 patients with similar age and gender receiving lobectomy surgery were collected as the control group.In a retrospective follow-up study,the clinical efficacy and safety of treatment were compared between the study(n=51)and control(n=50)groups.Kaplan-Meier survival analysis was used to assess the overall survival and local recurrence-free survival.COX analysis was used to evaluate the risk factors.Results Of the 101 patients,62 were male(61.4％),aged 60-85 years(average,72.3± 11.6 years).There was no significant difference in baseline characteristics,including age,gender,smoking,medical history,lung function,tumor size,pathological type and histological grading,tumor position and clinical stage between the two groups(P＞0.05).There were no serious complications in the MWA group during perioperative period,and 14 cases (27.5％)had a small amount of pneumothorax after operation,which were absorbed after special treatment.Five cases (9.8％)had a small amount of hemoptysis,7 cases(13.7％)had a small amount of pleural effusion,9 cases(17.6％)had low fever (＜ 38.5 ℃),and 9 cases (17.6 ％) had postoperative mild pain.There were no serious complications in the control group.The follow-up period was up to December 31,2018,and the median follow-up time was 11.7 months(4.5 20.3 months).During the follow-up,local recurrence occurred in 10 patients(9.9％),including 7 patients(13.7％)in the MWA group and 3 patients(6.0％)in the control group.There was no significant difference between the MWA group and the control group in the 1-year overall survival rate(92.2％ or 47 cases vs.96.0％ or 48 cases,P =0.313),tumor-specific survivalrate(100.0％ vs.100.0％,P=1.00),local recurrence free survival rate(86.3％ or 44 cases vs.94.0％ or 47 cases,P =0.156).Multivariate COX regression analysis showed age (HR =1.22,95 ％CI:1.06-1.38,P =0.004),tumor size (HR =1.75,95 ％ CI:1.14-2.36,P =0.005) and clinical stage of tumor(HR =1.53,95 ％ CI:1.17-1.89,P =0.001) were risk factors for the local recurrencefree survival.Conclusions MWA is an effective and safe treatment for elderly patients with early-stage lung cancer who are not suitable for surgery.Age,tumor diameter and clinical stage are risk factors for local recurrence-free survival.