Objective:To explore the specific mechanism of lactic acid(LA)on regulating decidual macrophage differentia-tion in pre-eclampsia(PE)through non-receptor tyrosine kinase sarcoma virus protein/lactate dehydrogenase A(SRC/LDHA)signaling pathway.Methods:Decidual tissues were collected from 16 women with preeclampsia(PE)and 16 women with normal pregnancies during the same period.Immunofluorescence was used to assess macrophage subtypes and LA secretion in decidual tissues.Biochemi-cal assays and Western blot were performed to measure levels of LA,LDHA and MCT-4 in tissues.Biochemical assays were conducted to measure LA level in supernatants of normal trophoblast cells under different cell densities and oxygen conditions.Flow cytometry was used to assess polarization of macrophages in normal decidual tissues under different conditions of LA,oxygen and culture media.qRT-PCR,Western blot,ROS,and NAD+/NADH measurements were performed to evaluate mRNA and protein levels related to gly-colysis and mitochondrial oxidative phosphorylation,as well as proteins associated with SRC/LDHA signaling pathway,ROS level,and NAD+/NADH.Thirty pregnant rats were divided into normal group,model group,low-,medium-,high-dose AZD3965 groups,with 6 rats in each group.PE model was established,and the systolic blood pressure and urinary protein levels of pregnant rats were measured at various time points.On gestational day 20,the placental and fetal development in each group were compared.Immunofluo-rescence was used to assess trophoblast cell invasion and uterine spiral artery remodeling in decidual tissues.Immunohistochemistry and flow cytometry were performed to evaluate fetal vascular development and macrophage polarization.Results:Compared with nor-mal pregnant women,patients with PE exhibited an increased proportion of M1 macrophages,CK7+LDHA+,CK7+MCT-4+cells,LA,LDHA and MCT-4(P<0.05),while proportion of M2 macrophages was decreased(P<0.05).Compared with normoxic conditions,LA level in supernatant of trophoblast cells was significantly increased under hypoxic conditions(P<0.05).Under normoxic condition,compared with control groups,conditioned culture group showed a decreased M1/M2 macrophage(P<0.05).LA group exhibited in-creased expressions of NDUFA1,NDUFA2,UQCRC1,UQCRC2,COX4I1,COX4I2,ATP5F1A,ATP5F1B mRNA,and SDHB,COX4I1,LDHB,p-SRC(Y416),p-LDHA(Y10),VEGF and ARG-1 protein(P<0.05).NAD+/NADH was decreased(P<0.05).PX478 group showed increased expression of p-SRC(P<0.05).LA+PX478 group exhibited increased expressions of p-SRC(Y416)and p-LDHA(Y10)(P<0.05),while VEGF expression was decreased(P<0.05).Under hypoxic conditions,compared with control groups,the conditioned culture group,LA group and LA+PX478 group exhibited an increased M1/M2 macrophage(P<0.05).LA group showed upregulated expressions of LDHA mRNA,HIF-1α,LDHA,p-SRC(Y416),p-LDHA(Y10)and iNOS(P<0.05),while mRNA expression of LDHB and protein expressions of NDUFA1 and UQCRC2 were downregulated(P<0.05).ROS level and NAD+/NADH were decreased(P<0.05).PX478 group demonstrated reduced HIF-1α expression(P<0.05)and increased p-SRC(Y416)expression(P<0.05).LA+PX478 group showed decreased HIF-1α expression(P<0.05)and increased p-LDHA(Y10)ex-pression(P<0.05).Compared with LA group,LA+PX478 group exhibited elevated ROS level(P<0.05)and a reduced NAD+/NADH(P<0.05).Compared with normal group,pregnant rats in model group exhibited increased blood pressure,urine protein levels and an elevated M1/M2 in decidual tissue(P<0.05).The fetal mice exhibited abnormal development,with inadequate trophoblast cell infiltra-tion,impaired uterine spiral artery remodeling,a decreased number of fetal blood vessels in placental labyrinthine layer,and nar-rowed lumens.Compared with model group,the low,medium,and high-dose AZD3965 groups showed decreased blood pressure,urine protein levels and M1/M2(P<0.05).Additionally,there was an improvement in fetal mouse development,trophoblast cell infil-tration and uterine spiral artery remodeling.The number of fetal blood vessels in placental labyrinthine layer increased,and the lu-mens expanded.Conclusion:LA can regulate macrophage polarization in decidua of PE through SRC/LDHA pathway,and blocking LA uptake can alleviate the pathological manifestations in pregnant rats with PE.

Objective:To explore the specific mechanism of lactic acid(LA)on regulating decidual macrophage differentia-tion in pre-eclampsia(PE)through non-receptor tyrosine kinase sarcoma virus protein/lactate dehydrogenase A(SRC/LDHA)signaling pathway.Methods:Decidual tissues were collected from 16 women with preeclampsia(PE)and 16 women with normal pregnancies during the same period.Immunofluorescence was used to assess macrophage subtypes and LA secretion in decidual tissues.Biochemi-cal assays and Western blot were performed to measure levels of LA,LDHA and MCT-4 in tissues.Biochemical assays were conducted to measure LA level in supernatants of normal trophoblast cells under different cell densities and oxygen conditions.Flow cytometry was used to assess polarization of macrophages in normal decidual tissues under different conditions of LA,oxygen and culture media.qRT-PCR,Western blot,ROS,and NAD+/NADH measurements were performed to evaluate mRNA and protein levels related to gly-colysis and mitochondrial oxidative phosphorylation,as well as proteins associated with SRC/LDHA signaling pathway,ROS level,and NAD+/NADH.Thirty pregnant rats were divided into normal group,model group,low-,medium-,high-dose AZD3965 groups,with 6 rats in each group.PE model was established,and the systolic blood pressure and urinary protein levels of pregnant rats were measured at various time points.On gestational day 20,the placental and fetal development in each group were compared.Immunofluo-rescence was used to assess trophoblast cell invasion and uterine spiral artery remodeling in decidual tissues.Immunohistochemistry and flow cytometry were performed to evaluate fetal vascular development and macrophage polarization.Results:Compared with nor-mal pregnant women,patients with PE exhibited an increased proportion of M1 macrophages,CK7+LDHA+,CK7+MCT-4+cells,LA,LDHA and MCT-4(P<0.05),while proportion of M2 macrophages was decreased(P<0.05).Compared with normoxic conditions,LA level in supernatant of trophoblast cells was significantly increased under hypoxic conditions(P<0.05).Under normoxic condition,compared with control groups,conditioned culture group showed a decreased M1/M2 macrophage(P<0.05).LA group exhibited in-creased expressions of NDUFA1,NDUFA2,UQCRC1,UQCRC2,COX4I1,COX4I2,ATP5F1A,ATP5F1B mRNA,and SDHB,COX4I1,LDHB,p-SRC(Y416),p-LDHA(Y10),VEGF and ARG-1 protein(P<0.05).NAD+/NADH was decreased(P<0.05).PX478 group showed increased expression of p-SRC(P<0.05).LA+PX478 group exhibited increased expressions of p-SRC(Y416)and p-LDHA(Y10)(P<0.05),while VEGF expression was decreased(P<0.05).Under hypoxic conditions,compared with control groups,the conditioned culture group,LA group and LA+PX478 group exhibited an increased M1/M2 macrophage(P<0.05).LA group showed upregulated expressions of LDHA mRNA,HIF-1α,LDHA,p-SRC(Y416),p-LDHA(Y10)and iNOS(P<0.05),while mRNA expression of LDHB and protein expressions of NDUFA1 and UQCRC2 were downregulated(P<0.05).ROS level and NAD+/NADH were decreased(P<0.05).PX478 group demonstrated reduced HIF-1α expression(P<0.05)and increased p-SRC(Y416)expression(P<0.05).LA+PX478 group showed decreased HIF-1α expression(P<0.05)and increased p-LDHA(Y10)ex-pression(P<0.05).Compared with LA group,LA+PX478 group exhibited elevated ROS level(P<0.05)and a reduced NAD+/NADH(P<0.05).Compared with normal group,pregnant rats in model group exhibited increased blood pressure,urine protein levels and an elevated M1/M2 in decidual tissue(P<0.05).The fetal mice exhibited abnormal development,with inadequate trophoblast cell infiltra-tion,impaired uterine spiral artery remodeling,a decreased number of fetal blood vessels in placental labyrinthine layer,and nar-rowed lumens.Compared with model group,the low,medium,and high-dose AZD3965 groups showed decreased blood pressure,urine protein levels and M1/M2(P<0.05).Additionally,there was an improvement in fetal mouse development,trophoblast cell infil-tration and uterine spiral artery remodeling.The number of fetal blood vessels in placental labyrinthine layer increased,and the lu-mens expanded.Conclusion:LA can regulate macrophage polarization in decidua of PE through SRC/LDHA pathway,and blocking LA uptake can alleviate the pathological manifestations in pregnant rats with PE.

Objective:To explore the optimal ratio of dihydrotestosterone and hydroxyflutamide (hereinafter referred to as DH), construct a dual release system of androgen and its antagonist, and analyze the application effect of this system in the repair of full-thickness burn wounds in mice.Methods:This study was an experimental study. The HaCaT cells were divided into blank group (without drug culture), low baseline group, medium baseline group, and high baseline group according to the random number table (the same grouping method below), and the last three groups of cells were cultured by adding three different ratios of DH. Under a medium ratio, the mass of dihydrotestosterone in the three baseline groups from low to high was 1.4, 2.8, and 4.0 μg, respectively, and the mass of hydroxyflutamide was 1.2, 1.6, and 2.0 μg, respectively. On this basis, under a small ratio, the mass of dihydrotestosterone was reduced by half and the mass of hydroxyflutamide was increased by half; under a large ratio, the mass of dihydrotestosterone was increased by half and the mass of hydroxyflutamide was reduced by half. After culture of 2 days, the cell proliferation level was detected by cell counting kit 8 ( n=4). Sixteen 6-8-week-old male BALB/c mice were used to establish a full-thickness burn wound on the back and divided into blank group, small ratio group, medium ratio group, and large ratio group, with 4 mice in each group. On post injury day (PID) 7, normal saline containing different ratios of DH was locally dropped to the wounds of mice in the last three groups of mice (the total mass of DH in the three ratio groups from small to large was 127.5, 165.0, and 202.5 μg, respectively, and the mass ratios of dihydrotestosterone to hydroxyflutamide (hereinafter referred to as drug mass ratio) were 8∶9, 8∶3, and 8∶1, respectively), afterwards, the administration was repeated every 48 hours until PID 27; normal saline was dropped to the wound of mice in blank group at the aforementioned time points. The wound healing status on PID 0 (immediately), 7, 14, 21, and 28 was observed, and the wound healing rates on PID 7, 14, 21, and 28 were calculated ( n=4). On PID 28, the wound tissue was taken, which was stained with hematoxylin and eosin for observing re-epithelialization and with Masson for observing collagen fibers, and the proportion of collagen fibers was analyzed ( n=3). Twenty 6-8-week-old male BALB/c mice were used to establish a full-thickness burn wound on the back and divided into ordinary scaffold group, small proportion scaffold group, medium proportion scaffold group, and large proportion scaffold group (with 5 mice in each group). On PID 7, the wound was continuously dressed with a polycaprolactone scaffold without drug and a polycaprolactone scaffold containing DH with a drug mass ratio of 1∶3, 1∶1, or 3∶1 (i.e. the dual release system of androgen and its antagonist, with total mass of DH being about 1.7 mg) prepared by using electrospinning technology until the end of the experiment. Histopathological analyses of tissue ( n=3) at the same time points as those in the previous animal experiment were performed. On PID 7 and 14, the wound exudates were collected and the relative abundance of bacterial communities was analyzed using 16S ribosomal RNA high-throughput sequencing ( n=3). Results:After culture of 2 days, under a small ratio, the proliferation levels of HaCaT cells in low baseline group and high baseline group were significantly higher than the level in blank group ( P<0.05). As the time after injury prolonged, the wounds of all four groups of mice continued to shrink. On PID 14, the wound healing rate of mice in large ratio group was 72.5% (61.7%, 75.1%), which was close to 53.3% (49.5%, 64.4%) in blank group ( P>0.05); the wound healing rates of mice in small and medium ratio groups were 74.2% (71.0%, 84.2%) and 70.4% (65.1%, 74.4%), respectively, which were significantly higher than the rate in blank group (with both Z values being -2.31, P<0.05). On PID 21, the wound healing rate of mice in small ratio group was significantly higher than that in blank group ( Z=-2.31, P<0.05). On PID 28, the wounds of mice in the three ratio groups were completely re-epithelialized and the epidermis was thicker than that in blank group; compared with that in blank group, the collagen fiber content in the wound tissue of mice in the three ratio groups was higher and arranged more orderly, and the proportions of collagen fibers in the wound tissue of mice in small and large ratio groups were significantly increased ( P<0.05). On PID 28, the wounds of mice in ordinary scaffold group were partially epithelialized, while the wounds of mice in the three proportion scaffold groups were almost completely epithelialized. Among them, the wounds of mice in small proportion scaffold group had the thickest epidermis. The proportion of collagen fibers in the wound tissue of mice in small proportion scaffold group was significantly increased compared with that in ordinary scaffold group ( P<0.05). On PID 7, the bacterial communities with high relative abundance in the wound exudation of mice in the four groups included bacteria of Corynebacterium, Staphylococcus, and Rhodococcus. On PID 14, the bacterial communities with high relative abundance in the wound exudation of mice in the four groups included bacteria of Stenotrophomonas, Rhodococcus, and Staphylococcus, and the number of bacterial species in the wound exudation of mice in the three proportion scaffold groups was more than that in ordinary scaffold group. Conclusions:When the drug mass ratio is relatively small, DH has the effect of promoting the proliferation of HaCaT cells. The ratio of 8∶9 is the optimal mass ratio of dihydrotestosterone to hydroxyflutamide, and DH with this mass ratio can promote re-epithelialization and collagen deposition of full-thickness burn wounds in mice, and promote wound healing. The constructed dual release system of androgen and its antagonist with DH in a 1∶3 drug mass ratio contributes to the re-epithelialization and collagen deposition of the full-thickness burn wounds in mice, and can improve the diversity of wound microbiota.

Objectives:To explore the spatial distribution characteristics, trend changes, and spatial clustering of esophageal cancer among residents in China at the county (city, district) scale, a spatial epidemiological approach was used, with the aim of providing localized evidence for the prevention and treatment of esophageal cancer in China.Methods:The data source was the incidence (crude rate) and mortality (crude rate) of esophageal cancer from 2005 to 2016 in the 2008-2019 edition of China Cancer Registration Annual Report published by the National Cancer Center. The Joinpoint model was used for time trend analysis. The tumor registration area in 2016 was selected as the study area for spatial feature analysis, with a total of 487 counties (cities and districts), covering 27.6% of the national population. Spatial autocorrelation analysis was performed to reveal spatial distribution characteristics by using Arcgis 10.6 software, and spatial scanning statistics was used to analyze spatial clustering characteristics by using SaTScan 9.5 software. The log-likelihood ratio ( LLR) and relative risk ( RR) were calculated in different windows, and the region with the largest LLR value represented the most likely cluster. Results:From 2005 to 2016, the incidence and mortality rate of esophageal cancer in China showed a trend of increasing at first and then decreasing. The incidence and mortality rate of esophageal cancer in 2016 were characterized by spatial positive correlation. High incidence and high mortality were mainly concentrated in the areas through which the Huaihe River flowed. The primary clusters (taking high incidence rate as an example LLR=6 374.41, RR=2.37, P＜0.001) were mainly distributed in Jiangsu, Anhui and Shandong in eastern China and eastern Henan and southern Hebei in central China, and secondary clusters (taking high incidence rate as an example LLR=1 971.19, RR=1.91, P＜0.001) in Gansu, Ningxia Hui Autonomous Region, Shaanxi, Sichuan and other central and western regions. Conclusions:The incidence and mortality of esophageal cancer in China have decreased since 2010. The disease burden of esophageal cancer has obvious spatial differences, and measures should be taken according to local conditions in high-risk cluster areas such as the Huaihe River basin.

Objective To explore the effects and action mechanism of miR-181c-5p on biological behaviors of pros-tate cancer cells.Methods The pathological relationship between BIRC5,miR-181c-5p and prostate cancer was analyzed based on prostate cancer data in TCGA database.The target binding site of miR-181c-5p and BIRC5 was analyzed by miRNA target gene prediction database,and was verified by double luciferase activity assay.The ex-pression of BIRC5 protein in miR-181 c-5p overexpression cells was detected by Western blot.The prostate cancer cells PC3 and DU145 were selected to construct cell line with miR-181c-5p overexpression(miR-181c-5p group)and its negative control(miR-NC group),and qRT-PCR verification was conducted.The cells proliferation[opti-cal density at 450 nm site(OD450 nm)]was detected by CCK-8.Distribution of cell cycles and apoptosis rate were detected by flow cytometry.Expressions of proliferation and apoptosis related proteins were detected by Western blot.The cell line with miR-181c-5p/BIRC5 overexpression was constructed(miR-181c-5p+BIRC5 group).Cells growth,distribution of cell cycles,apoptosis rate and expressions of related proteins were detected by the a-bove methods.Results The expression of BIRC5 was up-regulated in prostate cancer tissues,and it was higher in patients with high tumor invasion,lymph node metastasis and recurrence.Patients exhibiting high expression of BIRC5 demonstrated poor survival rates.The expression of miR-181c-5p was down-regulated in prostate cancer tis-sues.The level of miR-181c-5p was negatively correlated with BIRC5 level,and miR-181c-5p could inhibit BIRC5 expression.In PC3 and DU145,miR-181c-5p level in miR-181c-5p group was higher than that in miR-NC group(P＜0.05);OD450 nm and percentage of S-phase cells were lower than those in miR-NC group(P＜0.05),per-centage of cells in G0/G1 phase;apoptosis rate and expressions of BAX,caspase-3 and PARP proteins were higher than those in miR-NC group(P＜0.05);expressions of CDK2,CCNB1 and BCL-2 proteins were lower than those in miR-NC group(P＜0.05).The expression of BIRC5 protein and OD450 nm in miR-181 c-5p+BIRC5 group were higher than those in miR-181c-5p group(P＜0.05),percentage of cells in G0/G1 phase was lower than that in miR-181c-5p group(P＜0.05);percentage of S-phase cells was higher than that in miR-181c-5p group(P＜0.05);apoptosis rate was lower than that in miR-181c-5p group(P＜0.05);expressions of CDK2,CCNB1 and BCL-2 proteins were higher than those in miR-181c-5p group;expressions of BAX,caspase-3 and PARP proteins were lower than those in miR-181 c-5p group.Conclusion miR-181-5p can inhibit the proliferation of human pros-tate cancer cells by targeting BIRC5,block cells in G0/G,phase and promote cells apoptosis.

Objectives:To explore the spatial distribution characteristics, trend changes, and spatial clustering of esophageal cancer among residents in China at the county (city, district) scale, a spatial epidemiological approach was used, with the aim of providing localized evidence for the prevention and treatment of esophageal cancer in China.Methods:The data source was the incidence (crude rate) and mortality (crude rate) of esophageal cancer from 2005 to 2016 in the 2008-2019 edition of China Cancer Registration Annual Report published by the National Cancer Center. The Joinpoint model was used for time trend analysis. The tumor registration area in 2016 was selected as the study area for spatial feature analysis, with a total of 487 counties (cities and districts), covering 27.6% of the national population. Spatial autocorrelation analysis was performed to reveal spatial distribution characteristics by using Arcgis 10.6 software, and spatial scanning statistics was used to analyze spatial clustering characteristics by using SaTScan 9.5 software. The log-likelihood ratio ( LLR) and relative risk ( RR) were calculated in different windows, and the region with the largest LLR value represented the most likely cluster. Results:From 2005 to 2016, the incidence and mortality rate of esophageal cancer in China showed a trend of increasing at first and then decreasing. The incidence and mortality rate of esophageal cancer in 2016 were characterized by spatial positive correlation. High incidence and high mortality were mainly concentrated in the areas through which the Huaihe River flowed. The primary clusters (taking high incidence rate as an example LLR=6 374.41, RR=2.37, P＜0.001) were mainly distributed in Jiangsu, Anhui and Shandong in eastern China and eastern Henan and southern Hebei in central China, and secondary clusters (taking high incidence rate as an example LLR=1 971.19, RR=1.91, P＜0.001) in Gansu, Ningxia Hui Autonomous Region, Shaanxi, Sichuan and other central and western regions. Conclusions:The incidence and mortality of esophageal cancer in China have decreased since 2010. The disease burden of esophageal cancer has obvious spatial differences, and measures should be taken according to local conditions in high-risk cluster areas such as the Huaihe River basin.

Objective To observe the clinical efficacy of abdominal acupuncture combined with Dachaihu decoction in the treatment of gastrointestinal dysfunction in sepsis.Methods A prospective randomized controlled study was conducted.A total of 90 patients with sepsis and gastrointestinal dysfunction admitted to Shenzhen Hospital(Longgang),Beijing University of Chinese Medicine from December 2020 to May 2023 were selected as the research subjects.Patients were divided into a control group,a traditional Chinese medicine treatment group,and a comprehensive treatment group using a random number table method,with 30 cases in each group.After admission,all three groups received routine western medicine treatment,while the control group received a triple active capsule of mosapride citrate and bifidobacteria in addition to routine treatment;The traditional Chinese medicine treatment group was treated with Dachaihu decoction(consisting of Radix bupleuri 40 g,Scutellaria baicalensis 15 g,Pinellia ternata 15 g,Paeonia lactiflora 15 g,Fructus Aurantii 20 g,Jujube 15 g,Rhubarb 10 g,and Ginger 25 g)in addition to conventional treatment.This regimen involved one daily dose divided into 3 administrations.The comprehensive treatment group was treated with abdominal acupuncture in addition to the traditional Chinese medicine treatment group.Abdominal acupuncture adopts the Bo's abdominal acupuncture therapy,with a plan to select acupoints in Zhongwan,Xiawan,Qihai,Guanyuan,Daheng,Guanmen,Tianshu,and Taiyi.Acupuncture is administered once a day for 20 minutes each time.All 3 treatment groups have a duration of 8 days.Observe three groups of acute physiology and chronic health evaluationⅡ(APACHEⅡ),traditional Chinese medicine syndrome score,gastrointestinal dysfunction score,serum intestinal fatty acid binding protein(I-FABP),Occludin,zonula occludens-1(ZO-1),lipopolysaccharide(LPS),Toll like receptor 4(TLR4),interleukin-6(IL-6),procalcitonin(PCT),and nuclear factors-κB(NF-κB)before and after treatment changes in level.Record 3 groups of 28-day mortality,mechanical ventilation time,intensive care unit(ICU)hospitalization time,and total hospitalization time.Results On the 4th and 8th day of treatment,the APACHEⅡscore,gastrointestinal dysfunction score,traditional Chinese medicine syndrome score,and serum I-FABP,Occludin,ZO-1,LPS,TLR4,IL-6,PCT,NF-κB of three groups showed a significant downward trend,reaching a trough after 8 days of treatment,and the reduction in the comprehensive treatment group and the traditional Chinese medicine treatment group was more significant than that in the control group.The reduction in the comprehensive treatment group was more significant than those in the traditional Chinese medicine treatment group[APACHEⅡscore:13.37±4.54 vs.16.28±5.36,traditional Chinese medicine syndrome score:15.37±5.69 vs.18.72±6.34,gastrointestinal dysfunction score:6.22±1.56 vs.7.17±1.93,I-FABP(ng/L):8.38±2.69 vs.10.62±3.24,Occludin(ng/L):64.72±9.58 vs.75.66±11.45,ZO-1(ng/L):26.38±4.39 vs.30.26±5.77,LPS(EU/L):26.23±5.17 vs.34.52±7.41,TLR4(μg/L):7.47±2.63 vs.10.37±4.45,IL-6(ng/L):36.37±11.34 vs.43.69±12.56,PCT(μg/L):3.16±1.83 vs.6.38±3.25,NF-κB(μg/L):6.84±3.46 vs.10.43±5.65,all P<0.05].The mechanical ventilation time,ICU hospitalization time,and total hospitalization time of the comprehensive treatment group were all shorter than those of traditional Chinese medicine group and the control group[mechanical ventilation time(days):7.12±1.97 vs.8.29±2.23,9.68±2.87,ICU hospitalization time(days):9.27±3.22 vs.11.42±3.78,13.65±4.27,total hospitalization time(days):14.31±3.97 vs.16.65±4.74,19.54±5.33,all P<0.05].There was no statistically significant difference in the 28 day mortality among the comprehensive treatment group,traditional Chinese medicine treatment group,and control group[23.33%(7/30),33.33%(10/30)vs.46.67%(14/30),both P>0.05].Conclusion Dachaihu decoction can improve gastrointestinal function and clinical symptoms in patients with sepsis,the combination of Dachaihu decoction and abdominal acupuncture can more effectively promote gastrointestinal function recovery,reduce gastrointestinal mucosal damage,inhibit inflammatory reactions,shorten hospitalization time,and alleviate the condition.

Objective To observe the clinical efficacy of abdominal acupuncture combined with Dachaihu decoction in the treatment of gastrointestinal dysfunction in sepsis.Methods A prospective randomized controlled study was conducted.A total of 90 patients with sepsis and gastrointestinal dysfunction admitted to Shenzhen Hospital(Longgang),Beijing University of Chinese Medicine from December 2020 to May 2023 were selected as the research subjects.Patients were divided into a control group,a traditional Chinese medicine treatment group,and a comprehensive treatment group using a random number table method,with 30 cases in each group.After admission,all three groups received routine western medicine treatment,while the control group received a triple active capsule of mosapride citrate and bifidobacteria in addition to routine treatment;The traditional Chinese medicine treatment group was treated with Dachaihu decoction(consisting of Radix bupleuri 40 g,Scutellaria baicalensis 15 g,Pinellia ternata 15 g,Paeonia lactiflora 15 g,Fructus Aurantii 20 g,Jujube 15 g,Rhubarb 10 g,and Ginger 25 g)in addition to conventional treatment.This regimen involved one daily dose divided into 3 administrations.The comprehensive treatment group was treated with abdominal acupuncture in addition to the traditional Chinese medicine treatment group.Abdominal acupuncture adopts the Bo's abdominal acupuncture therapy,with a plan to select acupoints in Zhongwan,Xiawan,Qihai,Guanyuan,Daheng,Guanmen,Tianshu,and Taiyi.Acupuncture is administered once a day for 20 minutes each time.All 3 treatment groups have a duration of 8 days.Observe three groups of acute physiology and chronic health evaluationⅡ(APACHEⅡ),traditional Chinese medicine syndrome score,gastrointestinal dysfunction score,serum intestinal fatty acid binding protein(I-FABP),Occludin,zonula occludens-1(ZO-1),lipopolysaccharide(LPS),Toll like receptor 4(TLR4),interleukin-6(IL-6),procalcitonin(PCT),and nuclear factors-κB(NF-κB)before and after treatment changes in level.Record 3 groups of 28-day mortality,mechanical ventilation time,intensive care unit(ICU)hospitalization time,and total hospitalization time.Results On the 4th and 8th day of treatment,the APACHEⅡscore,gastrointestinal dysfunction score,traditional Chinese medicine syndrome score,and serum I-FABP,Occludin,ZO-1,LPS,TLR4,IL-6,PCT,NF-κB of three groups showed a significant downward trend,reaching a trough after 8 days of treatment,and the reduction in the comprehensive treatment group and the traditional Chinese medicine treatment group was more significant than that in the control group.The reduction in the comprehensive treatment group was more significant than those in the traditional Chinese medicine treatment group[APACHEⅡscore:13.37±4.54 vs.16.28±5.36,traditional Chinese medicine syndrome score:15.37±5.69 vs.18.72±6.34,gastrointestinal dysfunction score:6.22±1.56 vs.7.17±1.93,I-FABP(ng/L):8.38±2.69 vs.10.62±3.24,Occludin(ng/L):64.72±9.58 vs.75.66±11.45,ZO-1(ng/L):26.38±4.39 vs.30.26±5.77,LPS(EU/L):26.23±5.17 vs.34.52±7.41,TLR4(μg/L):7.47±2.63 vs.10.37±4.45,IL-6(ng/L):36.37±11.34 vs.43.69±12.56,PCT(μg/L):3.16±1.83 vs.6.38±3.25,NF-κB(μg/L):6.84±3.46 vs.10.43±5.65,all P<0.05].The mechanical ventilation time,ICU hospitalization time,and total hospitalization time of the comprehensive treatment group were all shorter than those of traditional Chinese medicine group and the control group[mechanical ventilation time(days):7.12±1.97 vs.8.29±2.23,9.68±2.87,ICU hospitalization time(days):9.27±3.22 vs.11.42±3.78,13.65±4.27,total hospitalization time(days):14.31±3.97 vs.16.65±4.74,19.54±5.33,all P<0.05].There was no statistically significant difference in the 28 day mortality among the comprehensive treatment group,traditional Chinese medicine treatment group,and control group[23.33%(7/30),33.33%(10/30)vs.46.67%(14/30),both P>0.05].Conclusion Dachaihu decoction can improve gastrointestinal function and clinical symptoms in patients with sepsis,the combination of Dachaihu decoction and abdominal acupuncture can more effectively promote gastrointestinal function recovery,reduce gastrointestinal mucosal damage,inhibit inflammatory reactions,shorten hospitalization time,and alleviate the condition.

【Objective:】 To preliminary construct a scientific, systematic and applicable evaluation index system of the interest conflict for medical institutions ethics committee. 【Methods:】 Literature retrieval, interpretation of laws and regulations, expert group discussion and Delphi expert letter inquiry were used to screen indicators and determine the evaluation index system of interest conflict and the weight of various indicators. 【Results:】 The response rates of the two rounds of correspondence questionnaire were both 100%, the authority coefficient Cr values of the two rounds were 0.855 and 0.865, and the coordination coefficient W values of the two rounds were 0.817 and 0.826, which were statistically significant (P<0.05). The final formed system included 3 first-level indicators, 10 second-level indicators and 25 third-level indicators. 【Conclusion:】 The evaluation index system of interest conflict for medical institution ethics committee is scientific and reliable.

Objective:To observe any effect of combining extracorporeal shock wave stimulation with proprioceptive neuromuscular facilitation (PNF) on the lower limb motor function of stroke survivors with foot drop.Methods:Thirty-six stroke survivors with foot drop were randomly divided into an extracorporeal shock wave group, a PNF group and a combination group, each of 12. The extracorporeal shock wave group and PNF group were given those therapies alone, while the combination group was provided with both. The extracorporeal shock wave therapy protocol was 2000 times on each muscle at an intensity of 2.5 bar and a frequency of 10Hz, twice a week for 4 weeks, while the PNF was provided at least 3 times per week for 4 weeks. Before and after the intervention, all of the participants were evaluated using the modified Ashworth scale (MAS), the 10-metre walk test (10 MWT) and the Fugl-Meyer lower limb motor function scale (FMA). Active range of the ankle joint and toe out angle were also observed.Results:After the intervention the lower limb muscle tone had decreased significantly in 8 of the PNF group members and in 9 of those in the extracorporeal shock wave group, but it has decreased significantly in all 12 members of the combination group. And the average magnitude of the improvement was also significantly greater in the combination group than in the other two groups. Moreover, significant differences were observed in the active range of the ankle joint after the treatment in the combination group, but not in the other two groups. After the intervention the average 10 MWT times and FMA scores of the PNF and combination groups had improved significantly, but not those of the extracorporeal shock wave group, but significant improvement in toe out angles was observed in all three groups, though the average improvement in the combination group was significantly greater than in the other 2 groups.Conclusion:Combining extracorporeal shock waves with PNF can effectively improve the lower limb motor function of stroke survivors with foot drop.