ObjectiveTo explore the mechanisms of action of Ganlu Xiaodu Dan in treating viral pneumonia by combining network pharmacology and molecular docking with in vivo experimental validation. MethodsNetwork pharmacology and molecular docking were used to predict the core components， target genes， and major pathways of Ganlu Xiaodu Dan. Molecular docking was then applied to verify the interactions between the core components and key targets. Sixty male C57BL/6 mice were randomly divided into six groups （n = 10 per group）， including blank， model， dexamethasone， and Ganlu Xiaodu Dan low-， medium-， and high-dose groups. The blank and model groups were gavaged with physiological saline （10 mL·kg^-1） every 12 h. The dexamethasone group received intraperitoneal injections of dexamethasone （5 mg·kg^-1）. The low-， medium-， and high-dose groups of Ganlu Xiaodu Dan were gavaged with solutions at concentrations of 7.2， 14.4， and 21.6 g·kg^-1， respectively， every 12 h. Lung wet/dry weight ratio （W/D） was measured. Hematoxylin-eosin （HE） staining was used to observe pathological changes in lung tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to determine the expression levels of tumor necrosis factor-α （TNF-α）， interleukin （IL）-17， and IL-1β in bronchoalveolar lavage fluid （BALF）. Western blot was performed to detect the expression of phosphoinositide 3-kinase （PI3K） and protein kinase B （Akt） in lung tissue for further validation. ResultsTwelve potential active components of Ganlu Xiaodu Dan were identified through network pharmacology. A total of 306 overlapping target genes were obtained between Ganlu Xiaodu Dan and viral pneumonia. PPI network analysis identified the top 20 key targets， and GO and KEGG enrichment analyses revealed the top 20 signaling pathways. An “active component–target–pathway” network was constructed. Molecular docking demonstrated strong affinity between the core components of Ganlu Xiaodu Dan and key targets related to viral pneumonia. In animal experiments， compared with the blank group， the model group showed severe bronchial epithelial damage， disordered alveolar structure， massive inflammatory cell infiltration， widened alveolar septa， and obvious interstitial edema. W/D， levels of IL-1β， TNF-α， and IL-17 in BALF， and protein expression of p-PI3K/PI3K and p-Akt/Akt in lung tissue were all significantly increased （P<0.05）. Compared with the model group， lung injury in the Ganlu Xiaodu Dan groups and the dexamethasone group was alleviated. W/D and TNF-α levels were significantly decreased （P<0.05）. IL-1β and IL-17 levels were significantly reduced in the medium- and high-dose groups and the dexamethasone group， and the protein expression levels of p-PI3K/PI3K and p-Akt/Akt in lung tissue were significantly decreased （P<0.05）. ConclusionGanlu Xiaodu Dan can alleviate lung injury in viral pneumonia by suppressing the inflammatory response， and its mechanism may be related to the inhibition of PI3K/Akt pathway activation.

ObjectiveTo explore the mechanisms of action of Ganlu Xiaodu Dan in treating viral pneumonia by combining network pharmacology and molecular docking with in vivo experimental validation. MethodsNetwork pharmacology and molecular docking were used to predict the core components， target genes， and major pathways of Ganlu Xiaodu Dan. Molecular docking was then applied to verify the interactions between the core components and key targets. Sixty male C57BL/6 mice were randomly divided into six groups （n = 10 per group）， including blank， model， dexamethasone， and Ganlu Xiaodu Dan low-， medium-， and high-dose groups. The blank and model groups were gavaged with physiological saline （10 mL·kg^-1） every 12 h. The dexamethasone group received intraperitoneal injections of dexamethasone （5 mg·kg^-1）. The low-， medium-， and high-dose groups of Ganlu Xiaodu Dan were gavaged with solutions at concentrations of 7.2， 14.4， and 21.6 g·kg^-1， respectively， every 12 h. Lung wet/dry weight ratio （W/D） was measured. Hematoxylin-eosin （HE） staining was used to observe pathological changes in lung tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to determine the expression levels of tumor necrosis factor-α （TNF-α）， interleukin （IL）-17， and IL-1β in bronchoalveolar lavage fluid （BALF）. Western blot was performed to detect the expression of phosphoinositide 3-kinase （PI3K） and protein kinase B （Akt） in lung tissue for further validation. ResultsTwelve potential active components of Ganlu Xiaodu Dan were identified through network pharmacology. A total of 306 overlapping target genes were obtained between Ganlu Xiaodu Dan and viral pneumonia. PPI network analysis identified the top 20 key targets， and GO and KEGG enrichment analyses revealed the top 20 signaling pathways. An “active component–target–pathway” network was constructed. Molecular docking demonstrated strong affinity between the core components of Ganlu Xiaodu Dan and key targets related to viral pneumonia. In animal experiments， compared with the blank group， the model group showed severe bronchial epithelial damage， disordered alveolar structure， massive inflammatory cell infiltration， widened alveolar septa， and obvious interstitial edema. W/D， levels of IL-1β， TNF-α， and IL-17 in BALF， and protein expression of p-PI3K/PI3K and p-Akt/Akt in lung tissue were all significantly increased （P<0.05）. Compared with the model group， lung injury in the Ganlu Xiaodu Dan groups and the dexamethasone group was alleviated. W/D and TNF-α levels were significantly decreased （P<0.05）. IL-1β and IL-17 levels were significantly reduced in the medium- and high-dose groups and the dexamethasone group， and the protein expression levels of p-PI3K/PI3K and p-Akt/Akt in lung tissue were significantly decreased （P<0.05）. ConclusionGanlu Xiaodu Dan can alleviate lung injury in viral pneumonia by suppressing the inflammatory response， and its mechanism may be related to the inhibition of PI3K/Akt pathway activation.

Objective:To investigate the clinical effect of super-thin free anterolateral thigh (ALT) flap at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defects of the foot.Methods:The clinical data of patients with foot soft tissue defects admitted to Northern Jiangsu People’s Hospital Affiliated to Yangzhou University from June 2017 to December 2022 were retrospectively analyzed. During the operation, the super-thin free ALT flap on the affected side was harvested at the junction of superficial and deep fat of superficial fascia to repair the foot wound. The donor site wound was sutured directly or repaired with full-thickness skin graft. The flap survival and complications were observed after the operation, and the operation effect was evaluated from the following five aspects. (1) The Maryland foot function score was used to evaluate the recovery of foot function. The full score was 100 points, of which 90-100 points were excellent, 75-89 points were good, 50-74 points were fair, and < 50 points were poor. (2) The Vancouver scar scale (VSS) was used to evaluate the scar condition of the foot. The total score was 0-15 points. The higher the score, the more serious the scar. (3) The cold intolerance symptom severity (CISS) scale was used to evaluate the cold tolerance of the affected foot. The total score was 4-100 points. The higher the score, the more serious the symptoms. (4) Measuring static two-point discrimination to evaluate foot sensation, the smaller the measured value, the better the sensory recovery. (5) The satisfaction of patients with foot appearance was investigated, which was divided into five grades: very satisfied, satisfied, general, dissatisfied and very dissatisfied. Descriptive analysis of the data was performed using SPSS 26.0 software.Results:A total of 13 patients with foot soft tissue defects were enrolled, including 8 males and 5 females. The mean age was 54.7 years (range, 39-70 years). There were 10 cases of left foot and 3 cases of right foot. The wound area after thorough debridement ranged from 5.5 cm ×5.0 cm to 22.0 cm ×18.0 cm. The operation time was (145.1 ± 30.6) min. The area of the flap was 6.0 cm×5.5 cm to 23.5 cm×19.0 cm, and the thickness was (5.2 ± 1.1) mm (range, 3.0- 6.5 mm). The wound at the donor site was sutured directly in 9 cases, and coverd with the abdominal full-thickness skin graft in 4 cases. After the operation, 1 patient had partial epidermal necrosis at the distal end of the flap, 1 patient had venous crisis.The flaps survived after symptomatic treatment. The remaining 11 flaps survived smoothly. The patients were followed up for 12 to 20 months, with an average of 16 months. The foot flaps were soft and free of damage, and no secondary fat reduction or plastic surgery was required. There were no complications such as wound dehiscence, skin graft necrosis, muscle hernia, and quadriceps weakness in 13 cases of donor site except for hypoesthesia caused by scar hyperplasia in 4 cases with skin graft. At the last follow-up, the Maryland foot function score was (87.4±7.3) points, of which 7 cases were excellent, 4 cases were good, and 2 cases were fair. The excellent and good rate was 11/13. The foot scar was not obvious, the VSS score was (3.2±1.2) points. The foot was more tolerant to cold and the sensory recovery was better, the CISS score was (37.5±7.1) points and the static two-point discrimination was (13.9±1.0) mm. One month after the operation, the results of patients’ satisfaction with foot appearance were as follows: 11 cases were very satisfied and 2 cases were satisfied.Conclusion:The super-thin free ALT flap is obtained at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defect of the foot, which can optimize the operation time. The appearance and function of the foot recover well after the operation, avoiding the secondary shaping operation, reducing the damage to the donor site, and the patients are satisfied.

Objective:To investigate the clinical effect of super-thin free anterolateral thigh (ALT) flap at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defects of the foot.Methods:The clinical data of patients with foot soft tissue defects admitted to Northern Jiangsu People’s Hospital Affiliated to Yangzhou University from June 2017 to December 2022 were retrospectively analyzed. During the operation, the super-thin free ALT flap on the affected side was harvested at the junction of superficial and deep fat of superficial fascia to repair the foot wound. The donor site wound was sutured directly or repaired with full-thickness skin graft. The flap survival and complications were observed after the operation, and the operation effect was evaluated from the following five aspects. (1) The Maryland foot function score was used to evaluate the recovery of foot function. The full score was 100 points, of which 90-100 points were excellent, 75-89 points were good, 50-74 points were fair, and < 50 points were poor. (2) The Vancouver scar scale (VSS) was used to evaluate the scar condition of the foot. The total score was 0-15 points. The higher the score, the more serious the scar. (3) The cold intolerance symptom severity (CISS) scale was used to evaluate the cold tolerance of the affected foot. The total score was 4-100 points. The higher the score, the more serious the symptoms. (4) Measuring static two-point discrimination to evaluate foot sensation, the smaller the measured value, the better the sensory recovery. (5) The satisfaction of patients with foot appearance was investigated, which was divided into five grades: very satisfied, satisfied, general, dissatisfied and very dissatisfied. Descriptive analysis of the data was performed using SPSS 26.0 software.Results:A total of 13 patients with foot soft tissue defects were enrolled, including 8 males and 5 females. The mean age was 54.7 years (range, 39-70 years). There were 10 cases of left foot and 3 cases of right foot. The wound area after thorough debridement ranged from 5.5 cm ×5.0 cm to 22.0 cm ×18.0 cm. The operation time was (145.1 ± 30.6) min. The area of the flap was 6.0 cm×5.5 cm to 23.5 cm×19.0 cm, and the thickness was (5.2 ± 1.1) mm (range, 3.0- 6.5 mm). The wound at the donor site was sutured directly in 9 cases, and coverd with the abdominal full-thickness skin graft in 4 cases. After the operation, 1 patient had partial epidermal necrosis at the distal end of the flap, 1 patient had venous crisis.The flaps survived after symptomatic treatment. The remaining 11 flaps survived smoothly. The patients were followed up for 12 to 20 months, with an average of 16 months. The foot flaps were soft and free of damage, and no secondary fat reduction or plastic surgery was required. There were no complications such as wound dehiscence, skin graft necrosis, muscle hernia, and quadriceps weakness in 13 cases of donor site except for hypoesthesia caused by scar hyperplasia in 4 cases with skin graft. At the last follow-up, the Maryland foot function score was (87.4±7.3) points, of which 7 cases were excellent, 4 cases were good, and 2 cases were fair. The excellent and good rate was 11/13. The foot scar was not obvious, the VSS score was (3.2±1.2) points. The foot was more tolerant to cold and the sensory recovery was better, the CISS score was (37.5±7.1) points and the static two-point discrimination was (13.9±1.0) mm. One month after the operation, the results of patients’ satisfaction with foot appearance were as follows: 11 cases were very satisfied and 2 cases were satisfied.Conclusion:The super-thin free ALT flap is obtained at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defect of the foot, which can optimize the operation time. The appearance and function of the foot recover well after the operation, avoiding the secondary shaping operation, reducing the damage to the donor site, and the patients are satisfied.

Objective This study aimed to evaluate the influence of ceramic type and thickness on the masking abili-ty and final aesthetic effects of chairside machinable all-ceramic crowns.Methods Six kinds from three types chairside machinable ceramic materials(IPS e.max CAD HT/MT/LT,IPS Empress LT,and VITA Suprinity HT/T)in shade A2 were fabricated to slice specimens into 1.0,1.5,and 2.0 mm-thick sections(n=10).The color parameters of the speci-mens against black and white tiles and four resin substrates(A2,A4,B3,and C4 shade)were measured with a spectro-photometer.The translucency parameter(TP)was calculated using color parameters measured over standard white and black backgrounds.The color differences(ΔE)were cal-culated between there substrate shades(A4,B3,C4)and A2 shade(control group).Two-way analysis of variance(ANOVA)was performed on the TP values.The two va-riables were ceramic type and ceramic thickness.Three-way ANOVA was used to determine the effects of ceramic materials,ceramic thickness,and substrate shades on the ΔE values,followed by Tukey test for multiple comparisons(α=0.05).Results Ceramic type,ceramic thickness,and sub-strate shade significantly affected the ΔE values(P<0.001).The L* and b* values of the specimens increased with in-creasing ceramic thickness,except in substrate A2,whereas the ΔE values decreased.The color difference of all 1.0 mm-thick specimens or all specimens over the substrates C4 shade exceeded the clinically acceptable threshold(ΔE>3.3).Conclusion The masking ability of chairside machinable all-ceramic crowns is influenced by ceramic type and thick-ness,and ceramic material.The thickness of ceramic less than 2.0 mm cannot mask the gray shade abutment.

Objective To observe the value of dual-source CT(DECT)virtual monoenergetic imaging(VMI)for differentiating prostate cancer(PC)and benign prostatic hyperplasia(BPH).Methods Thirty-three patients with PC(PC group)and 44 patients with BPH(BPH group)were retrospectively enrolled,and 40-100 keV(with 10 keV interval)VMI were reconstructed based on arterial phase DECT images,respectively.Clinical data,focal CT value and contrast-to-noise ratio(CNR)of VMI with different energy levels and conventional linear fusion images of arterial phase were compared between groups.Binary logistic regression models were constructed based on clinical data being significantly different between groups,focal CT value of VMI with energy level with the highest CNR,also focal CT value of conventional linear fusion images of arterial phase,respectively.The area under the receiver operating characteristic curve(AUC)was calculated to evaluate the efficacy of each model for differentiating PC and BPH.Results Free prostate-specific antigen(f-PSA),total prostate-specific antigen(t-PSA),focal CT value of 40-100 keV VMI and conventional linear fusion images of arterial phase in PC group were all higher,while short diameter in PC group was smaller than those in BPH group(all P＜0.05).Logistic regression models were constructed based on f-PSA,t-PSA,short diameter,CT value at 40 keV VMI and CT value at conventional linear fusion images of arterial phase,respectively,with AUC for differentiating PC and BPH of 0.879,0.902,0.701,0.911 and 0.857,respectively.Conclusion DECT VMI could be used as a supplementary examination for prostate diseases,and 40 keV VMI had the best efficacy for differentiating PC and BPH.

Objective This study aims to investigate the application of symptom group management using a mo-bile health platform in managing heart failure patients during convalescence.Methods The research involved pa-tients with chronic heart failure who were treated at a tertiary A hospital in Qingdao from June 2022 to December 2022.The experimental group consisted of 235 patients who were discharged after treatment in ward A,while the control group consisted of 235 patients who were discharged during the same period in ward B.The experimental group received an mHealth-based symptom clusters management program following routine continuous nursing and the control group was given routine continuous nursing after discharge.6 months after the intervention,the heart function status,self-care level,and quality of life were compared between 2 groups.Results The experimental group ultimately included 232 cases,while the control group ultimately included 225 cases.Furthermore,the cardiac functional status,level of self-care,and quality of life of both the experimental group and the control group showed improvement compared to the pre-intervention period(P＜0.05).The experimental group exhibited significantly better cardiac function status compared to the control group,and the experimental group demonstrated higher levels of self-care confidence,and quality of life relative to the control group(P＜0.05).Conclusion The utilization of a mobile medical platform can enhance the management of heart failure patients'symptom groups,resulting in im-proved disease management efficiency.This platform provides patients with a comprehensive self-management plan,ultimately enhancing their self-management abilities and overall outcomes.

Objective To systematically evaluate the experiences of drug self-management in elderly patients with multiple chronic illnesses,so as to provide references for the development of personalized drug self-management intervention programs.Methods Qualitative research on drug self-management experiences of elderly patients with multiple chronic diseases was retrieved from PubMed,Cochrane Library,Embase,CINAHL,Web of Science,Scopus,CNKI,Wanfang,VIP and SinoMed.The retrieval time limit is from the establishment of the databases to November 2023.The qualitative research quality evaluation criteria of the Joanna Briggs Institute Evidence-based Health Care Center in Australia was used to evaluate quality of studies.The results were integrated by meta-integration method.Results A total of 9 studies were included,and 33 research results were extracted,and 4 integrated results and 12 categories were synthesized.The integration results included the objective dilemmas and challenges of drug self-management,the low level of drug literacy,willingness to engage in positive behavior attempts,need of multi-party assistance.Conclusion The objective dilemmas of drug self-management and low level of drug literacy in elderly patients with multimorbidity will seriously affect their health outcomes.Medical staffs should pay attention to the different experiences of patients in the process of drug self-management,identify the needs of patients,formulate targeted intervention support strategies,and improve the level of drug self-management in elderly patients.

Objective This study aimed to explore the relationship between the spontaneous changes of mesiodistal angulation of lower second molars(L2M)and individual clinical characteristics in patients with early permanent dentition correction.Methods A total of 44 patients with a total of 88 mandibular second molars were included in this study after screening.Based on the frequency distribution histogram of the initial angle of inclina-tion(L2M initial angle)of the L2M crown before treatment,it was divided into three groups:Group A:small angle group,L2M initial angle is 0°～17.5°;Group B:medium angle group,L2M initial angle is 17.5°～42.5°;Group C:large angle group,L2M initial angle is 42.5°～60°.According to whether L2M has erupted and exposed most of the crown,it was divided into erupted group and unerupted group.According to the mandibular plane angle,it can be divided into high angle,low angle,and average angle.CBCT reconstructed panoramic images were used to measure the mesiodistal inclination of L2M and analyze the relationship between each group and the change in mesiodistal inclination angles of L2M.Results After treatment,L2M mesiodistal angulation in the small angle,large angle,non-eruption,and high angle groups became more significant.The angle in the middle angle group was significantly smaller.The L2M mesiodistal angulation in the eruption and average angle group did not change significantly.The angles of ANB,Y-axis,and mandibular plane have no correlation with the initial angle of L2M.Conclusion The L2M in patients with large and high angles is more likely to topple during a correc-tion.During the correction,the L2M tends to approach the normal axial inclination.

Objective To evaluate the intraoperative identification of ectopic parathyroid tissue in the central neck region using autofluorescence point-spectral analysis(AFPSA)combined with immune colloidal gold technique(ICGT),for guiding total parathyroidectomy(TPTX)or clean parathyroidectomy(CPTX)in the management of secondary hyperparathyroidism(SHPT).Methods Retrospectively collected and compared the clinical data of 64 patients with SHPT from October 2019 to June 2023.In the observation group,TPTX was performed as the initial procedure in 36 cases,followed by sampling of suspicious targets using AFPSA in the central neck area and subsequent detection through ICGT.CPTX was then conducted if a positive result was obtained.On the other hand,the control group consisted of 28 cases where only TPTX was performed without any additional tests during surgery.The surgical data,parathyroid hormone(PTH)levels,blood calcium levels,blood phosphorus levels,alkaline phosphatase(ALP)levels,regression of clinical symptoms,changes in parathyroid function and occurrence of hypocalcemia were compared between these two groups.Results In the observation group,there were 9 cases of AFPSA-ICGT positivity,including 2 left-sided cases,4 right-sided cases,and 3 thymic cases;among these posi-tive cases,there were a total of 10 locations with mildly hyperplastic or nonhyperplastic microscopic parathyroid tissue.The difference in the number of total parathyroid glands removed(including ectopic)between the two groups was statistically significant(P<0.05).At both 3 and 6 months postoperatively,ALP levels in the observation group were significantly lower than those in the control group(P<0.01 and P<0.001 respectively);at 6 months postoperatively,differences in PTH and blood phosphorus levels between the two groups were also statistically significant(P<0.05 and P<0.001 respectively).Joint bone pain and skin itching recurred in some patients within the control group at six months after surgery(P<0.05),whereas recurrence of SHPT was less frequent within the observation group compared to controls(P<0.05);however,no statistically significant differences were observed regarding postoperative hypoparathyroidism or hyperparathyroidism as well as hypocalcemia between either groups.Conclusion The AFPSA-ICGT intraoperative test can be utilized to guide surgery for SHPT,enabling accurate and efficient identification as well as safe targeting of parathyroid tissues that may not exhibit obvious hyperplasia in the central cervical region.