Objective To investigate the clinical efficacy of Xiaqi Decoction(mainly composed of Poria,Pinelliae Rhizoma Praeparatum,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle,Armeniacae Semen Amarum,Citri Grandis Exocarpium,Paeoniae Radix Alba,Polygoni Multiflori Radix,and Moutan Cortex)on patients with stage Ⅲ-Ⅳ colorectal cancer accompanied by cancer-related fatigue(CRF)after chemotherapy.Methods Sixty patients with stage Ⅲ-Ⅳ colorectal cancer accompanied by CRF after chemotherapy who admitted to Guangdong Second Traditional Chinese Medicine Hospital from January 2023 to March 2024 were randomly divided into chemotherapy group and Xiaqi Decoction group according to the random number table method,with 30 patients in each group.The chemotherapy group was given chemotherapy regimen of Avastin+mFOLFOX6/FOLFIRI,and Xiaqi Decoction group was given Xiaqi Decoction orally on the basis of treatment for the chemotherapy group.Two weeks constituted a course of treatment,and two consecutive courses of treatment were performed.Before and after treatment,the two groups were observed in the changes of Revised Piper Fatigue Scale(PFS-R)scores,EORTC Quality of Life Questionnaire-Core 30(QLQ-C30)scores,Patient-Generated Subjective Global Assessment(PG-SGA)scores,Karnofsky Performance Status(KPS)scores,poor appetite scores,and serum levels of interleukin 6(IL-6),tumor necrosis factor α(TNF-α),and interleukin 1β(IL-1β)were observed.After treatment,the clinical efficacy and safety between the two groups of patients were evaluated.Results(1)After two courses of treatment,the total effective rate of the Xiaqi Decoction group was 86.21%(25/29)and that of the chemotherapy group was 62.07%(18/29),and the intergroup comparison(tested by chi-square test)showed that the efficacy of Xiaqi Decoction group was significantly superior to that of chemotherapy group(P<0.05).(2)In the second and fourth weeks of chemotherapy,the PFS-R scores for evaluating the degree of fatigue of patients in the two groups were increased when compared with those in the day before chemotherapy(P<0.05),but the PFS-R scores in Xiaqi Decoction group were significantly lower than those in the chemotherapy group after chemotherapy(P<0.01).(3)In the second and fourth weeks of chemotherapy,the QLQ-C30 scores for evaluating the quality of life in the chemotherapy group was decreased when compared with that one day before chemotherapy(P<0.05),whereas the QLQ-C30 scores in the Xiaqi Decoction group showed no obvious changes when compared with that one day before chemotherapy(P>0.05).The intergroup comparison showed that the QLQ-C30 scores of the Xiaqi Decoction group were all significantly higher than those of the chemotherapy group after chemotherapy(P<0.01).(4)The evaluation of nutritional status showed that in the fourth week of chemotherapy,PG-SGA score and poor appetite score in the two groups as well as KPS score in Xiaqi Decoction group were increased when compared with those one day before chemotherapy(P<0.05),while the KPS score in the chemotherapy group was decreased when compared with that one day before chemotherapy(P<0.05).The intergroup comparison showed that PG-SGA score and poor appetite score of Xiaqi Decoction after chemotherapy were lower than those of the chemotherapy group,and the KPS score was higher than that of the chemotherapy group,the differences being statistically significant(P<0.05 or P<0.01).(5)In the chemotherapy group,the serum inflammatory factor levels of TNF-α and IL-6 in the second week of chemotherapy and the serum TNF-α,IL-1β and IL-6 levels in the fourth week of chemotherapy were all increased when compared with those one day before chemotherapy(P<0.05).In the Xiaqi Decoction group,the serum TNF-α,IL-1β,and IL-6 levels were all decreased when compared with those one day before chemotherapy,and significant differences were shown in the serum IL-6 level in the second week of chemotherapy and in the serum levels of IL-1β and IL-6 in the fourth week of chemotherapy when compared with those one day before chemotherapy(P<0.05).The intergroup comparison showed that serum TNF-α,IL-1β,and IL-6 levels in the Xiaqi Decoction group after chemotherapy were significantly lower than those in the chemotherapy group(P<0.05 or P<0.01).Conclusion Xiaqi Decoction is effective on relieving the clinical symptoms and enhancing the efficacy of patients receiving chemotherapy for stage Ⅲ-Ⅳ colorectal cancer.It can inhibit the expression of inflammatory factors,relieve the CRF and improve the nutritional status and the quality of life of the patients,with higher safety.

Objective To observe the therapeutic effect and mechanism of Xiaqi Decoction for mice with chemotherapy-induced cancer-related fatigue(CRF)in colon cancer.Methods The successfully constructed chemotherapy-induced CRF mouse model of colon cancer was randomly divided into the model control group and the Xiaqi Decoction group,with 10 mice in each group,and a blank control group was also set up.After each group was given the corresponding intervention,the mice exhaustive swimming time was determined,the tumor size was measured,the tumor inhibition rate was calculated,and the serum levels of inflammatory factors such as tumor necrosis factor(TNF)-α,interleukin(IL)-1β,IL-6 and other safety indicators such as alanine aminotransferase(ALT),aspartate aminotransferase(AST)and blood ureanitrogen(BUN)were detected by enzyme-linked immunosorbent assay(ELISA),the protein expression levels of Toll-like receptor 4(TLR4)and nuclear factor κB(NF-κB)p65 in the epithelial cells of tumor lumps(or axillary tissues)were detected by Western Blot.Results(1)Before treatment,the exhaustive swimming time of mice in the model control group was significantly less than that of the blank control group(P<0.01);after 28 days of treatment,the exhaustive swimming time of mice in the Xiaqi Decoction group was significantly longer than that of the model control group(P<0.01),and it was time-dependent.(2)The tumor size of mice in the Xiaqi Decoction group was gradually decreased from 4-28 days of treatment,and the tumor inhibition rate was 68.96%after 28 days of treatment.(3)The serum levels of TNF-α,IL-1β and IL-6 in the model control group were significantly higher than those in the blank control group(P<0.01);and the serum levels of TNF-α,IL-1β and IL-6 in the Xiaqi Decoction group were significantly lower than those in the model control group(P<0.05).(4)The serum levels of ALT,AST and BUN in the model control group were higher than those in the blank control group(P<0.05 or P<0.01);the serum levels of ALT,AST and BUN in the Xiaqi Decoction group were lower than those in the model control group(P<0.05).(5)The protein expression levels of TLR4 and NF-κB p65 in tumor epithelial cells of the model control group were higher than those of the blank control group(P<0.01);the protein expression levels of TLR4 and NF-κB p65 in tumor epithelial cells of the Xiaqi Decoction group were lower than those of the model control group(P<0.01).Conclusion Xiaqi Decoction can effectively promote physical recovery,and inhibit tumor growth in mice with chemotherapy-induced CRF of colon cancer,and its mechanism may be related to the inhibition of TLR4 and NF-κB p65 expression,thus to reduce the inflammatory response,with certain degree of safety.

Objective To evaluate the clinical efficacy of Chu-Needle Therapy combined with Kang'ai Injection in treating cancer-related fatigue(CRF)in colorectal cancer patients with qi-blood deficiency syndrome.Methods Eighty patients diagnosed with colorectal cancer accompanied by CRF and qi-blood deficiency syndrome were enrolled from the inpatient and outpatient departments of Guangdong Second Traditional Chinese Medicine Hospital between January 2023 and March 2024.Participants were randomly divided into an observation group(n=40)and a control group(n=40)using a random number table.The control group received Kang'ai Injection alone,while the observation group received additional Chu-Needle Therapy.Treatment courses lasted 7 days each,with two consecutive courses administered.After two weeks,clinical efficacy was evaluated by comparing Revised Piper Fatigue Scale scores,traditional Chinese medicine(TCM)syndrome scores,as well as red blood cell count(RBC),hemoglobin(HGB),and albumin(ALB)levels,and immune markers(CD3+,CD4+,CD8+,NK cells)before and after treatment.Safety and adverse reactions were also assessed.Results(1)After treatment,both groups showed significant improvements in all Piper Fatigue Scale(PFS)scores,including behavioral,sensory,affective,and cognitive dimensions,as well as total scores(P＜0.05).The observation group demonstrated significantly greater improvements in all PFS subscales and total scores compared to the control group,with statistically significant differences(P＜0.05).(2)After treatment,both groups exhibited marked reductions in TCM syndrome scores,including fatigue,palpitations,shortness of breath,pale complexion,dizziness,spontaneous or night sweating,limb numbness,poor appetite,pale nails,and total scores(P＜0.05).The observation group showed significantly better improvement in all TCM syndrome scores than the control group,with statistically significant differences(P＜0.05).(3)The total effective rate was 82.5％(33/40)in the observation group versus 40.00％(16/40)in the control group,indicating significantly superior therapeutic efficacy in the observation group,with statistically significant differences(P＜0.05).(4)After treatment,both groups demonstrated significant improvements in RBC,HGB,ALB levels(P＜0.05),with the observation group showing significantly greater improvements in these hematological parameters compared to the control group,with statistically significant differences(P＜0.05).(5)After-treatment,both groups showed significant changes in immune markers CD3+,CD4+,CD8+,or NK cells compared to baseline(P＜0.05).The observation group exhibited significantly better modulation of CD3+,CD4+,CD8+,and NK cell levels than the control group,with statistically significant differences(P＜0.05).(6)The incidence of adverse reactions was 5.00％(2/40)in the observation group versus 22.50％(9/40)in the control group,indicating significantly better safety profile in the observation group,with statistically significant differences(P＜0.05).Conclusion Chu-Needle Therapy combined with Kang'ai Injection significantly alleviates fatigue,improves clinical symptoms,enhances nutritional status and immune function,and elevates quality of life in colorectal cancer patients with CRF and qi-blood deficiency syndrome,demonstrating notable clinical efficacy.

OBJECTIVE: To investigate the effectiveness of one-stage total knee arthroplasty (TKA) in the treatment of advanced active knee tuberculosis. METHODS: The clinical data of 38 patients with advanced active knee tuberculosis who received one-stage TKA between January 2011 and December 2020 were retrospectively analyzed. There were 20 males and 18 females. The age ranged from 20 to 84 years, with an average of 52.8 years. The body mass index ranged from 17 to 36 kg/m ², with an average of 23.05 kg/m ². The preoperative C reactive protein (CRP) was (23.49±4.72) mg/L, erythrocyte sedimentation rate (ESR) was (45.95±8.82) mm/1 h. The Hospital for Special Surgery (HSS) score was 48.8±9.1. During the operation, the infected lesions of the knee joint were completely removed, and the operative area was repeatedly soaked with 3% hydrogen peroxide solution and 0.5% povidone iodine solution. The intraoperative pathological examination confirmed the tuberculosis of the knee joint, and systemic anti-tuberculosis treatment was performed. The operation time, postoperative hospitalization stay, postoperative anti-tuberculosis chemotherapy time, and complications were recorded. CRP and ESR were recorded and compared before and after operation. Anteroposterior and lateral X-ray films of the knee joint were taken to evaluate whether the prosthesis had signs of loosening and sinking, and to determine whether there was recurrence of tuberculosis. The knee joint function was evaluated by HSS score. With treatment failure due to any reason as the end event, the survival time of prosthesis was analyzed by Kaplan-Meier survival curve. RESULTS: All operations were successfully completed without fracture, vascular and nerve injury, deep vein thrombosis, and other complications. All incisions healed by first intention after operation. The operation time ranged from 80 to 135 minutes, with an average of 102.76 minutes; postoperative hospitalization stay was 5-16 days, with an average of 9.7 days; the duration of postoperative anti-tuberculosis chemotherapy ranged from 1 to 18 months, and the median duration was 12 months. All 38 cases were followed up 3-133 months (mean, 63.7 months). At last follow-up, CRP was (4.88±1.24) mg/L and ESR was (13.00±2.97) mm/1 h, both of which were significantly lower than those before operation ( t=20.647, P<0.001; t=20.886, P<0.001). During the follow-up, 3 patients (7.89%) had tuberculosis recurrence. Two patients had tuberculosis recurrence due to withdrawal of anti-tuberculosis chemotherapy at 1 and 2 months after operation, respectively. One patient was cured after debridement, preservation of prosthesis and anti-tuberculosis chemotherapy for 12 months, and 1 patient was cured after oral administration of anti-tuberculosis drugs for 12 months. Another 1 patient had recurrent tuberculosis and mixed infection ( Corynebacterium gehreni) at 2 months after operation, and the infection was not controlled after debridement, and finally the thigh was amputated. Except for the patients with recurrent infection, no complications such as prosthesis loosening, periprosthetic fracture, and periprosthetic infection were found. At last follow-up, the HSS score of the knee joint was 86.8±4.8, and the knee joint function significantly improved when compared with that before operation ( t=-31.198, P<0.001). Prosthesis survival time was (122.57±5.77) months [95% CI (111.25, 133.88) months], and the 10-year survival rate was 92.1%. CONCLUSION One-stage TKA combined with postoperative antituberculous chemotherapy in the treatment of advanced active knee tuberculosis can achieve satisfactory infection control and joint function.
Female ; Male ; Humans ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; Retrospective Studies ; Knee Joint ; Tuberculosis ; Antitubercular Agents/therapeutic use*

Objective: To analyze the correlation between circumcision and incidence and clearance of male genital HPV infection. Methods: From May to July 2014, 18-55 year old men who had sexual behavior history were recruited from the general population in Liuzhou, Guangxi to set up a cohort. Totally, 113 circumcised and 560 uncircumcised men were enrolled and interviewed using a questionnaire (including information on demographic characteristics and sexual behaviors), then they were followed-up with 6-month interval for 2 times. On each visit, specimens of male external genitalia were collected and genotyped for HPV DNA. The differences of incidence and clearance of genital HPV infections between circumcised and uncircumcised men were analyzed by Log-rank test. Cox regression was used to analyze the relationship between circumcision and incidence and clearance of HPV infection. Results: The median age (P₂₅, P₇₅) of circumcised and uncircumcised men were 28 (24, 35) and 32 (24, 31), respectively. The incidences of any HPV infections were 9.1 (95%CI: 2.4-15.7) and 8.4 (95% CI: 5.6-11.2) per 1 000 person-months (χ²=0.10, P=0.758), respectively. The clearance of circumcised men [136.3 (95%CI: 70.0-202.7) per 1 000 person-months] was higher than that in uncircumcised men [89.6 (95%CI: 65.9-113.3) per 1 000 person-months] (χ²=8.19, P=0.004). In multivariate COX regression analysis, compared with uncircumcised men, circumcised men had higher possibility to clear any HPV infections (HR: 2.41, 95%CI: 1.30-4.46). Compared with men having one sexual partner, people having more than 4 sexual partners had lower possibility to clear any HPV infections (HR: 0.49, 95%CI: 0.25-0.96). Compared with 18-25 years old men, men aged 26-35 years old had higher possibility to clear high-risk HPV infections (HR: 2.14, 95%CI: 1.08-4.23). Conclusion Circumcised and uncircumcised men had similar incidence of genital HPV infection, whereas, men conducted circumcision and having fewer sexual partners could increase the clearance of genital HPV infections.

Objective To explore the selection of medical unit and the major influencing factors among residents in Hubei province,to allocate reasonably the health resources and provide reference for developing medical policy.Methods With the method of multi-stage stratified cluster sampling,household survey were done.The multilevel statistical model was used to analyze the influencing factors of the first diagnosed agencies.Results The proportions of residents who chose primary medical institutions as the first diagnosed agencies were 64.5％ in urban areas and 84.3％ in rural areas,and the visiting rate decreased as the level of health care institutions increased.The selection of first diagnosed agencies among patients were related to district (city or village,OR=0.463,95％CI..0.254-0.842),age (OR=1.023,95％CI:1.010-1.036),the educational attainment (OR＞1.000),illness duration in days (OR=0.945,95％CI:0.917-0.973) and number of days in bed (OR=0.854,95 ％ CI:0.825-0.884).Conclusion The residents who chose primary medical institutions as the first diagnosed agencies took a large proportion.District,age,the educational attainment and the illness duration in days had influence on the selection of the first diagnosed agencies among residents.

Objective: To investigate the seroprevalence and epidemiological characteristics of hepatitis E virus (HEV) infection in pregnant women in Xiamen. Methods: Sera samples of 910 pregnant women were collected from September 2014 to June 2015 in Xiamen Huli District Maternity and Child Care Hospital. Those who intended to give birth in target hospital were included in a subgroup which was asked to collect the second serum sample. All samples were tested for anti-HEV IgM and IgG antibody by enzyme linked immunosorbent assay (ELISA). HEV RNA was tested by reverse transcription-polymerase chain reaction (RT-PCR) for the positive samples of anti-HEV IgM antibody, meanwhile, the quantitative detections for anti-HEV IgG were conducted in specimens positive for anti-HEV IgG. Results: Of the 910 pregnant women, 8 (0.88%, 95%CI 0.45%-1.73%) were anti-HEV IgM positive. HEV RNA was found in 3 cases through RT-PCR and viral load values were between 600 and 700 copies/ml; 140 (15.38%, 95%CI 13.19%-17.68%) were anti-HEV IgG positive and geometric mean concentration of the samples was 0.385 Wu/mL (95%CI 0.332-0.445 Wu/ml). The positive rate of anti-HEV IgG increased with age (P=0.004). In the subgroup, 150 pregnant women were included and followed up, 4 of those were defined as 'new HEV infection cases’ and the incidence was evaluated as 10.7/100 person-year (95%CI 3.39-25.7/100 person-year). Conclusions There were a low percentage of HEV carriers in pregnant women in Xiamen, but the risk of new primary infection in pregnant women during pregnancy was much higher than the general population, suggesting that it is necessary to expand sample size to clarify the burden of HEV infection during pregnancy.

Objective To investigate the association between single nucleotide polymorphisms in the intron 1 of thyroid stimnulating hormone receptor gene (TSHR) and Graves' disease (GD) in the Chinese Han population from Linyi city,Shandong Province.Methods A total of 1759 GD patients and 1740 control subjects were recruited for genotyping in TSHR intron 1 with genome-wide association study (GWAS) and Taqman probe technique.At the same time,serum thyroid hormone and TSH receptor antibody (TRAb) levels of patients were determined.Results Five SNPs were selected for further replication.The rs12101261 _T was significantly associated with GD risk ( OR=1.257,95％CI 1.137-1.390,P =8.23 × 10-6 ). Logistic regression identified that rs12101261 was an independent susceptibility locus of GD ( P=1.61 × 10-3 ).Furthermore,rs12101261 _T was strongly associated with GD ( OR =1.317,95％ CI 1.171-1.481,P=4.14× 10-4 ) in TRAb positive patients,but no association in TRAb negative patients ( OR=1.056,95％ CI 0.892-1.251,P=0.524 ).Serum TRAb concentration showed remarkable difference among three genotype groups of rs12101261.Conclusions Five SNPs in TSHR intron 1 are associated with GD.rs12101261 contributes to increased GD risk independently and is associated with serum TRAb level.