Colorectal tumorigenesis generally progresses from adenoma to adenocarcinoma, accompanied by dynamic changes in the tumor microenvironment (TME). A randomized controlled trial has confirmed the efficacy and safety of Shen-Bai-Jie-Du decoction (SBJDD) in preventing colorectal tumorigenesis. However, the mechanism remains unclear. In this study, we employed single-cell RNA sequencing (scRNA-seq) to investigate the dynamic evolution of the TME and validated cell infiltration with multiplex immunohistochemistry and flow cytometry. Bulk RNA sequencing was utilized to assess the underlying mechanisms. Our results constructed the mutually verifiable single-cell transcriptomic atlases in Apc ^Min/+ mice and clinical patients. There was a marked accumulation of CCL22⁺ dendritic cells (DCs) and an enhanced immunosuppressive action, which SBJDD and berberine reversed. Combined treatment with cholesterol and lipopolysaccharide induced characteristic gene expression of CCL22⁺ DCs, which may represent "exhausted DCs". Intraperitoneal injection of these DCs after SBJDD treatment eliminated its therapeutic effects. TMEM131 derived CCL22⁺ DCs generation by TNF signaling pathway and may be a potential target of berberine in retarding colorectal tumorigenesis. These findings emphasize the role of exhausted DCs and the regulatory mechanisms of SBJDD and berberine in colorectal cancer (CRC), suggesting that the multi-component properties of SBJDD may help restore TME homeostasis and offer novel cancer therapy.

OBJECTIVE: To observe the clinical effect and safety of fire needle therapy combined with bladder function training on neurogenic bladder (NB) caused by spinal cord injury. METHODS: A total of 60 patients with NB caused by spinal cord injury were randomly divided into an observation group and a control group , with 30 cases in each group. On the basis of conventional treatment with western medicine, the bladder function training was adopted in the control group, once a day and for 4 weeks. In the observation group, on the basis of the interventions as the control group, fire needling was operated at bilateral Sanyinjiao (SP 6) and Guanyuan (CV 4) and Zhongji (CV 3), once every two days and for 4 weeks (14 interventions in total). Separately, at the baseline and in 2 and 4 weeks of interventions, the urination conditions (average daily urination frequency, average daily leakage frequency, average daily single urination volume) were recorded in the two groups; the urodynamic parameters (maximum flow rate [Qmax], maximum detrusor pressure at maximum flow rate [PdetQmax], residual urine volume [RUA], maximum cystometric capacity [MCC], and bladder pressure) were detected; the neurogenic bladder symptom score (NBSS), urinary symptom distress score (USDS) were observed. Before and after treatment, the score of World Health Organization quality of life assessment scale-brief (WHOQOL-BREF) was observed in the two groups. The therapeutic effect, the incidence of urinary infection, and the safety were evaluated. RESULTS: In 2 and 4 weeks of interventions, the average daily urination frequency, the average daily leakage frequency, RUA, and the scores of NBSS and USDS decreased in the two groups when compared with the baseline (P<0.05). In 4 weeks of interventions, the above-mention outcomes were lower than those in 2 weeks of interventions (P<0.05); and the results in the observation group were lower in 2 and 4 weeks of interventions when compared with the control group (P<0.05). In 2 and 4 weeks of interventions, the average daily single urination volume, Qmax, PdetQmax, MCC, and bladder pressure increased in the two groups compared with the baseline (P<0.05). In 4 weeks of interventions, the above-mention outcomes were elevated in comparison with those in 2 weeks of interventions (P<0.05); and except for bladder pressure, the results in the observation group in 2 and 4 weeks of interventions were higher when compared with the control group (P<0.05). In 4 weeks of interventions, the scores of each dimension and the total scores of WHOQOL-BREF increased in comparison with the baseline in the two groups (P<0.05), and the scores of the observation group were higher than those of the control group (P<0.05). The incidence of urinary infection was 0% (0/30) in the observation group and 10.0% (3/30) in the control group, without significant difference (P>0.05). The total effective rate of the observation group was 93.3% (28/30), which was higher than that (73.3%, 22/30) of the control group (P<0.05). No serious adverse reactions occurred in the patients of the observation group. CONCLUSION Fire needle therapy combined with bladder function training can effectively relieve the clinical symptoms, ameliorate urination, restore bladder function and improve the quality of life in the patients with NB caused by spinal cord injury. This therapeutic regimen presents a high safety in practice.
Humans ; Spinal Cord Injuries/therapy* ; Female ; Male ; Acupuncture Therapy ; Middle Aged ; Adult ; Urinary Bladder, Neurogenic/etiology* ; Urinary Bladder/physiopathology* ; Urination ; Young Adult ; Treatment Outcome ; Aged ; Adolescent ; Combined Modality Therapy

Objective:To evaluate the clinical efficacy of intermediate frequency pulse electrical stimulation combined with TCM directional drug penetration therapy in the treatment of patients with lumbar spinal stenosis.Methods:Randomized controlled trial. Totally 90 patients with lumbar spinal stenosis who were treated between July 2018 and December 2021 in the hospital were selected according to randomized controlled trial design, and they were divided into the two groups through the random number table method, with 45 cases in each group. The control group was given non-steroidal anti-inflammatory drugs+conventional intermittent traction + intermediate frequency pulse electrical stimulation, and the combined group was treated with TCM directional drug penetration therapy on the basis of the control group. Both groups were continuously treated for 1 month. The TCM syndromes were scored before and after treatment, and Visual Analogue Scale (VAS) was used to evaluate the pain degree. Japanese Orthopedic Association (JOA) and Oswestry Disability Index (ODI) were applied to assess the dysfunction degree and quality of life, and the clinical efficacy was assessed.Results:The total effective rate was 95.56% (43/45) in combined group and was 82.22% (37/45) in control group, with statistical significance ( χ2=4.05, P=0.044). The scores of lumbago pain, articular soreness, knee soreness and weakness and impaired activity and total score in combined group after treatment were lower than those in the control group ( t=18.40, 15.81, 15.40, 26.50, 59.575, P<0.01), and the JOA score was higher than that of the control group ( t=5.62, P<0.01), while the ODI score was lower than that of the control group ( t=9.43, P<0.01). The time-point effect and between-group effect of VAS score in combined group were lower than those in the control group with the extension of time ( F=240.00, 17.19, P<0.01), and there was an interaction effect between decrease and treatment method ( F=6.66, P<0.01). Conclusion:Intermediate frequency pulse electrical stimulation combined with TCM directional drug penetration therapy is helpful to relieve the pain, improve the lumbar dysfunction degree and enhance the quality of life and clinical efficacy in patients with lumbar spinal stenosis.

ObjectiveTo investigate the mechanism by which Shenbai Jiedu prescription （SBJDF） inhibits the proliferation of colorectal cancer （CRC） HCT116 cells. MethodAfter 48 h treatment of HCT116 cells with SBJDF （0， 0.25， 0.5， 1， 2， 4 g·L^-1）， the viability of HCT116 cells were determined by methyl thiazolyl tetrazolium （MTT） colorimetry. Following the classification of cells into blank control group and SBJDF （1， 2， 4 g·L^-1） groups， the effect of SBJDF on HCT116 cell morphology was observed under an inverted microscope. The effects of SBJDF on the proliferation of HCT116 cells and mitochondrial membrane potential （Δψm） were detected by colony formation assay and JC-1 probe， respectively. The flow cytometry was then performed for determining cell cycle distribution and apoptosis. The effects of SBJDF on cell cycle-， apoptosis-， and nuclear factor kappa-B （NF-κB） signaling pathway-related proteins were determined by Western blot. ResultSBJDF effectively inhibited the vitality of HCT116 cells and changed their morphology in a concentration-dependent manner. Compared with the blank control group， SBJDF at 1， 2， 4 g·L^-1 significantly reduced cell colony formation （P<0.05， P<0.01），and SBJDF at 2 and 4 g·L^-1 arrested the HCT116 cell cycle at G₀/G₁ phase （P<0.05， P<0.01）. Compared with the blank control group， SBJDF at 1， 2， 4 g·L^-1 remarkably down-regulated the protein expression of CyclinD₁ （P<0.05， P<0.01）. SBJDF at 2 and 4 g·L^-1 lowered the CyclinA₂ and cyclin-dependent kinase 4 （CDK4） （P<0.05， P<0.01）. SBJDF at 4 g·L^-1 reduced the cyclin-dependent kinase 1 （CDK1） （P<0.01）. Compared with the blank control group， SBJDF at 2 and 4 g·L^-1 induced HCT116 cell apoptosis， down-regulated the protein expression of anti-apoptosis-related proteins Bcl-2 and Bcl-xl as well as the NF-κB signaling pathway-related proteins IκB kinase α （IKKα），inhibitor α of NF-κB （IκBα），and phospho-NF-κB p65 （p-p65） （P<0.05， P<0.01）， and diminished the mitochondrial membrane potential of HCT116 cells. ConclusionSBJDF inhibits the proliferation of HCT116 cells， which may be related to its inhibition of the activation of NF-κB signaling pathway and the induction of cell cycle arrest and apoptosis.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective To investigate the situation and the causes of neonatal death in Henan Province.Methods This study retrospectively analyzed the clinical data of 277 neonates who died at 18 hospitals in Henan Province in 2017.Distribution and causes of neonatal deaths,differences between perinatal conditions of premature and term/post-term infants,causes of early (＜ 7 d) and late (7-28 d) neonatal deaths and the differences in neonatal death cases between Maternal and Child Health Care Hospitals and General/Children's Hospitals were analyzed.We used t,rank-sum and Chi-square test (or corrected Chi-square test,or Fisher's exact test) for statistical analysis.Results (1) A total of 50 993 newboms were admitted to the 18 hospitals in 2017,297 of which died with a mortality of 5.82‰.After excluding 20 cases with uncertain birth or maternal pregnancy history or clinical data,277 cases with complete data were analyzed.Among them,168 (60.6％) were preterm neonates and 109 (39.4％) were term/post-term ones.Early and late neonatal deaths accounted for 74.0％ (205 cases) and 26.0％ (72 cases),respectively.(2) The top five causes of neonatal deaths were infection (78 cases,28.2％),asphyxia (54 cases,19.5％),neonatal respiratory distress syndrome (NRDS,33 cases,11.9％),severe congenital malformations (26 cases,9.4％) including cyanotic congenital heart diseases,digestive malformations,airway malformations and neural tube defects and pulmonary hemorrhage (23 cases,8.3％).Among them,the top three causes of early neonatal deaths were asphyxia (48 cases,23.4％),infection (43 cases,21.0％) and NRDS (33 cases,16.1％),while the main causes of late neonatal deaths were infection (35 cases,48.6％),major congenital malformations (9 cases,12.5％) and chromosome abnormities/inherited metabolic diseases (7 cases,9.7％).(3) Maternal complications during pregnancy accounted for 79.1％ (219 cases) and the predominant types were pregnancy-induced hypertension (43 cases,19.6％),followed by infection (36 cases,16.4％),placental-related conditions (32 cases,14.6％),gestational diabetes mellitus (23 cases,10.5％),hypothyroidism (20 cases,9.1％),fetal distress (18,8.2％),twin-twin transfusion syndrome (10 cases,4.6％) and cholestasis syndrome (9 cases,4.1％).(4) Compared with the term/post-term cases,the preterm cases had higher proportions of multiple births [27.4％ (46/168) vs 6.4％ (9/109),x2=14.016,P ＜ 0.05],assisted reproduction [7.1％ (12/168) vs 0.9％ (1/109),x2=4.421,P ＜ 0.05] and maternal hypertensive disorders of pregnancy [21.4％ (36/1 68) vs 6.4％ (7/109),x2=11.353,P ＜ 0.05],infection [16.7％ (28/168) vs 7.3％ (8/109),x2=4.295,P ＜ 0.05] and twin-to-twin transfusion syndrome [6.0％ (10/168) vs 0.0％ (0/109),x2=6.707,P ＜ 0.05].(5) Among all the early neonatal deaths,preterm cases had a higher incidence of NRDS than term/post-term neonates [20.3％ (27/133) vs 8.3％ (6/72),x2=1 1.937,P ＜ 0.05],but lower incidence of meconium aspiration syndrome (MAS),severe congenital malformations and chromosome abnormalities/inherited metabolic diseases [0.8％ (1/133) vs 5.6％ (4/72),x2=4.508;3.8％ (5/133) vs 16.7％ (12/72),x2=10.233;1.5％ (2/133) vs 6.9％ (5/72),~=4.172;all P ＜ 0.05].Among the late neonatal deaths,the incidence of severe intracranial hemorrhage in preterm infants was higher than that in term/post-term neonates [7.1％ (3/42) vs 0.0％ (0/30),x2=2.205,P ＜ 0.05].(6) Compared with the cases in General/Children's Hospitals,those in Maternal and Child Health Care Hospitals showed a higher proportion of preterm neonatal deaths [67.3％ (105/156) vs 52.1％ (63/121),x2=6.010,P ＜ 0.05],younger gestational age [(32.8±5.3) weeks vs (34.6±4.9) weeks,t=3.072,P ＜ 0.05],lower birth weight [(2 132.6± 1 014.5) g vs (2 409.4±987.3) g,t=-2.513,P ＜ 0.05],and higher average age of death [M(P25-P75),3 (1-8) d vs 2 (1-4) d,Z=3.710,P ＜ 0.05].Conclusions Neonatal death occurs mainly within one week after birth in those with maternal complications.Late preterm deaths and term/post-term cases account for nearly half of total neonatal deaths.The causes of death for preterm and term/post-term newborns vary with postnatal age.Infection,asphyxia and severe congenital malformations are important causes of neonatal deaths.

Objective To study nursing of ureteral calculi patients treated by holmium laser lithotripsy by ureteral soft mirror under general anesthesia.Methods A total of 118 patients with ureteral calculi in our hospital were randomly divided into control group and observation group according to the double blind number method,all patients carried out general anesthesia by soft ureteral holmium laser lithotripsy,the control group was given routine nursing care and the observation group was given intensive care.And the nursing results of patients were statistically analyzed.Results The observation group had higher one-time success rate of clear stone than the control group (91.53％ vs.81.36％,P ＜ 0.05);The incidence rates of complications in the observation group was 3.39％,which was significantly lower than 8.47％ in the control group(P ＜0.05).The hospitalization time,SDS score,VAS score and SAS score of the observation group were significantly better than that of the control group (P ＜ 0.05).The observation group had significantly higher related knowledge and treatment compliance than that in the control group(88.14％,91.53％ vs.76.27％,74.58％,P ＜0.05).Conclusion Holmium laser lithotripsy by ureteral soft mirror under general anesthesia can strengthen treatment cooperation,the awareness of related disease knowledge,improve the rehabilitation effect of patients,and it is worth of popularizing.

Objective To study nursing of ureteral calculi patients treated by holmium laser lithotripsy by ureteral soft mirror under general anesthesia.Methods A total of 118 patients with ureteral calculi in our hospital were randomly divided into control group and observation group according to the double blind number method,all patients carried out general anesthesia by soft ureteral holmium laser lithotripsy,the control group was given routine nursing care and the observation group was given intensive care.And the nursing results of patients were statistically analyzed.Results The observation group had higher one-time success rate of clear stone than the control group (91.53％ vs.81.36％,P ＜ 0.05);The incidence rates of complications in the observation group was 3.39％,which was significantly lower than 8.47％ in the control group(P ＜0.05).The hospitalization time,SDS score,VAS score and SAS score of the observation group were significantly better than that of the control group (P ＜ 0.05).The observation group had significantly higher related knowledge and treatment compliance than that in the control group(88.14％,91.53％ vs.76.27％,74.58％,P ＜0.05).Conclusion Holmium laser lithotripsy by ureteral soft mirror under general anesthesia can strengthen treatment cooperation,the awareness of related disease knowledge,improve the rehabilitation effect of patients,and it is worth of popularizing.

Objective To investigate the risk factors for the occurrence of cerebral infarction in patients with capsular warning syndrome (CWS). Methods Consecutive patients with transient ischemic attack (TIA) meeting the CWS clinical manifestations were col ected retrospectively. They were divided into either a cerebral infarction group or a non-cerebral infarction group according to the brain diffusion weighted imaging findings. The independent risk factors for patients with CWS were identified through the comparison of demographic and baseline clinical data. Results A total of 39 patients were enrol ed, including 25 males (64. 1%) and 14 females (35. 9%), and their mean age was 58. 9 ± 10. 3 years. There were 21 patients in the cerebral infarction group and 18 in the non-cerebral infarction group. Compared with the non-cerebral infarction group, the age of patients in the cerebral infarction group was older (62. 5 ± 9. 3 years vs. 54. 8 ± 10. 2 years;t=2. 470, P=0. 018). The constituent ratio of the patients with a history of previous stroke or transient ischemic attack was higher (33. 3% vs. 5. 6%; P=0. 049), the fasting blood glucose level was higher (8. 2 ± 3. 2 mmol/L vs. 6. 0 ± 1. 3 mmol/L; t=2. 748, P=0. 009), and ABCD2 score was higher (5. 2 ± 1. 1 vs. 3. 5 ± 1. 1;t=4. 734, P<0. 001). Multivariate logistic regression analysis showed that the ABCD2 score was an independent risk factor for cerebral infarction in patients with CWS (odds ratio, 4. 529, 95% confidence interval 1. 233-16. 627;P=0. 023). Conclusions The higher ABCD2 score was an independent risk factor for the occurrence of cerebral infarction in patients with CWS. It can be used as an evaluation tool for predicting the risk of cerebral infarction in patients with CWS.

Objective To compared and analyze the therapeutic effect of conservative treatment on distal radius fracture as compared with surgical treatment,so as to provide evidence for the diagnosis and treatment of distal radius fracture.Methods A retro-spective analysis was made on the clinical data of 162 patients with distal radius fracture treated in our hospital from January 2005 to De-cember 2011.In accordance with the different treatment methods,the patients were divided into 2 groups:the conservative treatment group and the surgical treatment group.The patients in the conservative treatment group consisted of 95 patients,including 58 males and 37 females,with an age range between 21 and 64,averaging 52.8 years old.There were 47 cases of extra-articular fracture (type A fracture),28 cases of partial intra-articular fracture (type B fracture)and 20 cases of complicated intra-articular fracture (type C fracture).They were fresh closed fractures and were sent to hospital within 8 hours after fracture.After manual reposition,they had plaster splint for 4 to 7 weeks.The surgical treatment group contained 40 male and 27 female patients,with an age range between 22 and 65,averaging 53.1 years old.The control group included 31 type A fractures,22 type B fractures and 14 type C fractures.T-form steel plates were used for fixation of fractures after surgical reposition.Medical follow-ups were performed 12 to 41 months after surgery (averaging 14.5 months),and therapeutic effects were observed by using reposition scores and function test scores.Results Of the
162 patients,139 patients fulfilled the 12 to 41-month (averaging 14.5 months)medical follow-ups,including 80 cases in the conser-vative treatment group and 59 cases in the surgery group.With regard to function test scores,35 cases were of excellent rate,20 cases were of good rate and 4 cases were of moderate rate for the surgical treatment group.As for the conservative treatment group,45 cases were of excellent rate,25 cases were of good rate,8 cases were of moderate rate and 2 cases were of poor rate.Excellent rates for type A,B and C fractures accounted for 89.47% (17 /19),94.12% (16 /17)and 92.31% (12 /13)respectively,all with satisfactory therapeutic results.As for conservative treatment group,excellent rates for type A,B and C fractures accounted for 94.59% (35 /37), 91.67% (22 /24)and 68.42% (13 /19)respectively.There was no statistical significance in the reposition scores of type A and B fractures and function test scores,when comparisons were made between the surgical and conservative treatment groups(P >0.05). However,the reposition scores of type C fracture and function test scores for the surgical treatment group were obviously superior to those of the conservative treatment group,with statistical significance (P <0.01).Conclusion As for type A and B fractures,manual reposition plus external splint fixation and surgical reposition plus internal fixation could all achieve relatively good therapeutic results, whereas surgical reposition plus internal fixation for type C fracture could achieve better results.