Yigongsan is derived from Xiaoer Yaozheng Zhijue written by QIAN Yi in the Northern Song dynasty， which is the No. 3 formula in the Catalogue of Ancient Famous Classical Formulas（The Second Batch of Pediatrics） released by the National Administration of Traditional Chinese Medicine（TCM） in September 2022， and it can be developed as a class 3.1 new TCM drug. By referring to ancient medical books and modern literature， this study conducted herbal textual research on Yigongsan from five aspects， including historical evolution， origin and processing， dosage conversion， usage and preparation methods， and functional application， then formed the key information table of this formula， in order to provide reference for the development of reference samples and preparations of Yigongsan. Based on the results of the study， it is recommended that Panax ginseng should be removed the basal part of stem（rhizoma）， Poria cocos should be removed the peel， Citrus reticulata should be cut into shreds and Glycyrrhiza uralensis should be used. According to 4.13 g/Qian（钱）， 1 g/slice for ginger， 3 g for each jujube and 300 mL/Zhan（盏）， the doses of Ginseng Radix， Poria， Atractylodis Macrocephalae Rhizoma， Glycyrrhizae Radix et Rhizoma， Citri Reticulatae Pericarpium， Zingiberis Rhizoma Recens， Jujubae Fructus were 1.652， 1.652， 1.652， 1.652， 1.652， 5， 6 g， and the total amount was 19.26 g. The decocting method was to crush the medicinal materials into fine powder with 50-80 mesh， add 300 mL of water and decoct to 210 mL for each dose， then remove the dregs and take it warmly. This formula was recorded in ancient books as the main treatment for the cold-deficiency of spleen and stomach， and Qi stagnation in children with vomiting and diarrhea and lack of appetite. It has been flexibly applied by later generations of physicians， and is often used to treat anorexia， inflammation of the digestive tract， diarrhea and other diseases in children.

Objective:This report presents the initial outcomes of endoscopic intermuscular dissection (EID), a novel technique introduced by our team for the diagnostic resection of early rectal cancer, focusing on the postoperative status of the vertical margins.Methods:On January 26, 2024, a patient with early rectal cancer (cT1-2N0M0) underwent Endoscopic Intermuscular Dissection. The EID procedure consists of six steps: (1) mucosal incision; (2) submucosal dissection; (3) superficial muscular layer incision; (4) intermuscular dissection; (5) complete tumor removal; (6) wound management.Results:The patient was a 70-year-old male with rectal cancer (cT1-2N0M0). The tumor was located on the left anterior wall of the rectum, approximately 9 cm from the anal margin, and measured 20mm in size. The dissection rate was 2.68 mm2/minute, and the total duration of the surgery was 109 minutes. The patient was successfully discharged on the fifth day after surgery. Pathological examination of the post-endoscopic surgery specimen revealed pT1b, with negative vertical margins. Follow-up after more than one month showed good recovery with no complications such as bleeding, perforation, infection, or stricture occurring. Colonoscopy indicated the presence of a granulation tissue suggestive of inflammation.Conclusion:Endoscopic Intermuscular Dissection for the diagnostic resection of early rectal cancer is potentially safe and may achieve negative vertical margins.

Objective:This report presents the initial outcomes of endoscopic intermuscular dissection (EID), a novel technique introduced by our team for the diagnostic resection of early rectal cancer, focusing on the postoperative status of the vertical margins.Methods:On January 26, 2024, a patient with early rectal cancer (cT1-2N0M0) underwent Endoscopic Intermuscular Dissection. The EID procedure consists of six steps: (1) mucosal incision; (2) submucosal dissection; (3) superficial muscular layer incision; (4) intermuscular dissection; (5) complete tumor removal; (6) wound management.Results:The patient was a 70-year-old male with rectal cancer (cT1-2N0M0). The tumor was located on the left anterior wall of the rectum, approximately 9 cm from the anal margin, and measured 20mm in size. The dissection rate was 2.68 mm2/minute, and the total duration of the surgery was 109 minutes. The patient was successfully discharged on the fifth day after surgery. Pathological examination of the post-endoscopic surgery specimen revealed pT1b, with negative vertical margins. Follow-up after more than one month showed good recovery with no complications such as bleeding, perforation, infection, or stricture occurring. Colonoscopy indicated the presence of a granulation tissue suggestive of inflammation.Conclusion:Endoscopic Intermuscular Dissection for the diagnostic resection of early rectal cancer is potentially safe and may achieve negative vertical margins.

Objective:To investigate the association between gestational blood pressure and neurodevelopment in 2-year-old children.Methods:Based on the"Wuhan Healthy Baby Birth Cohort", 3 754 mother-infant pairs were enrolled in this study. Based on multiple blood pressure measurements during pregnancy, the mean, cumulative, and variability of blood pressure throughout the entire pregnancy and each trimester were calculated. Blood pressure variability was evaluated using standard deviation (SD), coefficient of variability (CV), and variability independent of mean (VIM). Follow-up testing of neurodevelopment in infants and young children at the age of two was conducted to obtain the Mental Development Index (MDI) and the Psychomotor Development Index (PDI). The multivariate linear regression and generalized estimation equation were used to analyze the association between gestational blood pressure data and neurodevelopmental index.Results:The age of 3 754 pregnant women was (29.1±3.6) years, with a pre-pregnancy BMI of (20.9±2.7) kg/m2 and a gestational age of (39.3±1.2) weeks. The birth weight of 3 754 children was (3 330.9±397.7) grams, and the birth length was (50.3±1.6) centimeters. The results of the multivariate linear regression analysis showed that after adjusting for relevant confounding factors, the mean blood pressure, cumulative blood pressure, standard deviation of blood pressure, coefficient of variation of blood pressure, independent blood pressure variability of systolic blood pressure, diastolic blood pressure, and pulse pressure throughout pregnancy were negatively associated with the MDI and PDI scores of 2-year-old children. The analysis results of the generalized estimation equation showed that after adjusting for relevant confounding factors, the average systolic blood pressure in the first, second, and third trimesters was negatively associated with MDI/PDI. The negative association between cumulative blood pressure and MDI/PDI was only found in the first trimester. The negative association between blood pressure variation during pregnancy and MDI/PDI was mainly concentrated in the second and third trimesters.Conclusion:There is a negative association between gestational blood pressure and the neurodevelopmental index of 2-year-old children.

Objective:To investigate the association between gestational blood pressure and neurodevelopment in 2-year-old children.Methods:Based on the"Wuhan Healthy Baby Birth Cohort", 3 754 mother-infant pairs were enrolled in this study. Based on multiple blood pressure measurements during pregnancy, the mean, cumulative, and variability of blood pressure throughout the entire pregnancy and each trimester were calculated. Blood pressure variability was evaluated using standard deviation (SD), coefficient of variability (CV), and variability independent of mean (VIM). Follow-up testing of neurodevelopment in infants and young children at the age of two was conducted to obtain the Mental Development Index (MDI) and the Psychomotor Development Index (PDI). The multivariate linear regression and generalized estimation equation were used to analyze the association between gestational blood pressure data and neurodevelopmental index.Results:The age of 3 754 pregnant women was (29.1±3.6) years, with a pre-pregnancy BMI of (20.9±2.7) kg/m2 and a gestational age of (39.3±1.2) weeks. The birth weight of 3 754 children was (3 330.9±397.7) grams, and the birth length was (50.3±1.6) centimeters. The results of the multivariate linear regression analysis showed that after adjusting for relevant confounding factors, the mean blood pressure, cumulative blood pressure, standard deviation of blood pressure, coefficient of variation of blood pressure, independent blood pressure variability of systolic blood pressure, diastolic blood pressure, and pulse pressure throughout pregnancy were negatively associated with the MDI and PDI scores of 2-year-old children. The analysis results of the generalized estimation equation showed that after adjusting for relevant confounding factors, the average systolic blood pressure in the first, second, and third trimesters was negatively associated with MDI/PDI. The negative association between cumulative blood pressure and MDI/PDI was only found in the first trimester. The negative association between blood pressure variation during pregnancy and MDI/PDI was mainly concentrated in the second and third trimesters.Conclusion:There is a negative association between gestational blood pressure and the neurodevelopmental index of 2-year-old children.

Objective:To investigate the feasibility, clinical efficacy and donor site impact of the deep inferior epigastric artery perforator flap (DIEPF) with transverse symmetrical design in reconstruction of soft tissue defects in limbs.Methods:From September 2020 to August 2023, 12 patients with soft tissue defects of limbs who agreed to flap donor site in the lower abdominal wall were treated in the Department of Hand Surgery and Microsurgery, Sichuan Modern Hospital. There were 10 females and 2 males with an average age of 58.42 years old. Defect sites: 3 in upper limbs and 9 in lower limbs. Sizes of the soft tissue defect were 8.0 cm×15.0 cm-13.0 cm×40.0 cm. CTA or CDU was used to detect the perforators of deep inferior epigastric artery and appropriate perforators were selected. The width and length of redundant skin and subcutaneous tissues in the lower abdomen were evaluated according to the "pinch and lift test". Taking into account the requirements of abdominoplasty, symmetrical bilateral DIEPFs were designed in the transverse direction on the lower abdominal wall. The sizes of the flaps were 7.5 cm×24.0 cm-13.0 cm ×42.0 cm. The harvested flaps were firstly thinned under the microscope, trimmed and shaped properly to match the profile of the wounds. Blood circulation was reconstructed with various forms of vascular anastomoses, such as internal pressurisation, connection in series and Flow-through, etc. Lower abdominal wall wound should be gradually reduced in tension according to the requirements of abdominal wall plastic surgery, and cosmetic suturing should be performed.Results:All 12 DIEPFs survived. The lower abdominal donor site healed primarily. All patients were included in postoperative follow-up for 6 to 42 (average 18.31) months. All flaps were normal in colour and soft in texture. The appearance of abdominal walls were improved, and the function was not affected, except 1 patient who underwent debulking procedure 3 months after the surgery.Conclusion:The transverse symmetrical design of a DIEPF is an ideal method for reconstruction of soft tissue defects in limbs after appropriate flap modification. It is a win-win solution for an aesthetic appearance of donor and recipient sites of the flap.

Objective:To elucidate the spatial distribution patterns of the right hepatic vein by analyzing the image information obtained after CT three-dimension reconstruction of liver to provide guidance in surgical planning of anatomical hepatectomy.Methods:A retrospective analysis was performed on the clinical data of 77 subjects who underwent CT examination of the liver at the Second Affiliated Hospital of Harbin Medical University from September 2018 to October 2021. There were 42 males and 35 females, aged (50.2±12.8) years old. CT DICOM data of the patients were collected, and the two-dimensional image data were reconstructed into a three-dimensional model by using the 3D reconstruction software. The characteristics and typing were studied by analyzing the number of branches of the right hepatic vein and the spatial location of the main trunk.Results:Of 77 subjects, 645 branches of the right hepatic vein were observed in the liver CT 3D reconstruction model, including 268 (41.6%) right-sided branches, 240 (37.2%) dorsal branches, 70 (10.9%) left-sided branches, and 67 (10.3%) ventral branches. Each right hepatic vein possessed 3 (3, 4) right-sided branches, 3 (3, 4) dorsal branches, 1 (0, 1) left-sided branch, and 1 (0, 1) ventral branch. The numbers of branches in the four directions were significantly different ( H=175.89, P<0.001). Comparison showed that the number of right-sided branches was significantly more than that of the left-sided (χ 2=136.86) and ventral (χ 2=140.07), respectively. The number of dorsal branches was more than that of left-sided (χ 2=-123.36) and ventral (χ 2=126.57) branches, respectively. The differences were significant ( P<0.001). There were no significant differences between the number of ventral and left-sided branches, and between the dorsal and right-sided branches (all P>0.05). Conclusion:The right hepatic vein had fewer ventral and left-sided branches. It is relatively safe to dissect the right hepatic vein from the ventral or the left side during surgery. For resection of the central liver segments or segment VIII of the liver, it is reasonable to transect the liver along the left border of the right hepatic vein.

Objective:To evaluate the effect of dexmedetomidine-based anesthesia on intestinal barrier function in the patients with acute intestinal obstruction.Methods:Ninety-four patients with acute intestinal barrier obstruction, aged 33-81 yr, weighing 48-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, were divided into 2 groups ( n=47 each) using a random number table method: routine anesthesia group (group R) and dexmedetomidine-based anesthesia group (group D). In group D, dexmedetomidine was intravenously injected in a loading dose of 1 μg/kg at 15 min before induction of general anesthesia followed by an infusion of 0.5 μg·kg -1·h -1 until 30 min before the end of operation.Before infusing the loading dose of dexmedetomidine, at 1 day after surgery, at 3 days after surgery, and at 7 days after surgery, peripheral venous blood samples were collected to measure the concentrations of diamine oxidase, D-lactic acid, bacterial endotoxin, tumor necrosis factor-α and interleukin-6.The occurrence of postoperative complications, anal exhaust time and average length of hospital stay were recorded. Results:Compared with group R, the concentrations of diamine oxidase, D-lactic acid, bacterial endotoxin, tumor necrosis factor-α and interleukin-6 were significantly decreased at 1 and 3 days after surgery, anal exhaust time and average length of hospital stay were shortened, and the requirement for respiratory cycle support and total incidence of complications were decreased in group D ( P<0.05). Conclusion:Dexmedetomidine-based anesthesia can improve intestinal barrier function to a certain extent in patients with acute intestinal obstruction.

OBJECTIVETo investigate the safety, feasibility, clinical value, indication, and distribution of diagnostic diseases in different age groups of colonoscopy in pediatric patients.

METHODSA retrospective analysis was performed on the data of pediatric patients receiving colonoscopy from April 2013 to June 2016 at The Sixth Affiliated Hospital of Sun Yat-sen University. Pediatric patients were divided into 0-6 years group (n=57) and 7-14 years group (n=172). Indication for colonoscopy, detective events and diagnostic diseases distribution were compared between two groups.

RESULTSA total of 229 pediatric patients (male 157 and female 72) were divided into 0-6 years group (57/229, 24.9%) and 7-14 years group(172/229, 75.1%). The main Indications for colonoscopy included abdominal pain (81/229, 35.4%), hematochezia (64/229, 27.9%), crissum abscess or fistula (40/229, 17.5%). Hematochezia was the most common complaint in 0-6 years group (40/57, 70.2%), while abdominal pain in 7-14 years group (74/172, 43.0%). Completion rate between 0-6 years group and 7-14 years group was not significantly different (87.72% vs. 85.47%, χ=0.181, P=0.671). Only one pediatric patient (1/229, 0.4%) developed transient oxygen desaturation and recovered quickly after oxygen supply and aspiration of sputum. No serious complications such as bleeding, perforation or death occurred. Including 45 pediatric patients in 0-6 years group and 102 pediatric patients in 7-14 years group, a total of 147 pediatric patients (147/229, 64.2%) were found to have colorectal lesions. Inflammatory bowel disease (57/147, 38.8%), colonic polyps (40/147, 27.2%) and other intestinal inflammation (39/147, 26.5%) were the main findings. The most frequent diagnosis in 0-6 years group was colonic polyps (28/57, 49.1%), among them, 25 pediatric patients (25/28, 89.3%) were with the complaint of hematochezia. The most frequent diagnosis in 7-14 years group was Inflammatory bowel disease (54/172, 31.4%), among them, 29 pediatric patients (29/54, 53.7%) were with the complaint of abdominal pain.

CONCLUSIONSPediatric colonoscopy is safe and effective. Hematochezia and abdominal pain are the most common complaints in 0-6 years group and 7-14 years group respectively. Colonic polyps and inflammatory bowel disease are the most frequent diagnosis in 0-6 years group and 7-14 years group respectively.

This study was aimed to investigate the effect of sinomenine on the expression of tumor suppressor gene P 16 and P53 in rats with lung cancer.A total of 40 male SD rats were treated by left-lung vein injection of WALKER-256 cell suspension to establish transplanted lung cancer model.After 3 weeks,30 rats screened of tumor were randomly divided into the model group,cyclophosphamide (CP) group and the sinomenine treatment group.Another 10 healthy SD rats were set as the normal control group.Sinomenine treatment group was treated with the subcutaneous injection of 10％ sinomenine hydrochloride for 10 weeks.CP was injected in the CP group as positive control.The same amount of normal saline was injected in the normal control group and the model control group.After 10 weeks of treatments,lung tumors of each group were removed to measure the tumor volume and weight.And the tumor inhibition rate was calculated.Then,flow cytometry was used to detect the proportion of WALKER-256 cells in tumor tissues in G1,G2,M and S around four cycles.Immunohistochemistry was adopted to detect positive expression rates of P16 and P53 protein.Reverse transcription polymerase chain reaction (RT-PCR) were used to detect expression of P16mRNA and P53mRNA.The results showed that compared with the model control group,the inhibition rate of sinomenine group was 30.15％;the positive expression rate of P16mRNA and P53mRNA protein were significantly decreased;expressions of P 16mRNA and P53mRNA were lower;tumor volume and tumor weight in S period got down significantly.The rates of cells in G1 and G2 periods got higher (P＜0.05).It was concluded that sinomenine may inhibit the differentiation and proliferation of WALKER-256 transplanted lung cancer cells in rats by regulating the expression of tumor suppressor gene P 16 and P53,regulating the ratio of cells in G1,G2 and S periods.