Esophageal cancer （EC） is a highly prevalent malignant tumor in China. The phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， as one of the key oncogenic pathways， can promote the cell cycle progression， proliferation， migration， and invasion， induce chemoresistance， and inhibit apoptosis and autophagy of EC cells. Traditional Chinese medicine （TCM）， with the advantages of targeting multiple points with multiple components to delay cancer progression， can target the PI3K/Akt signaling pathway for EC treatment. This article preliminarily discusses the molecular mechanism and role of the PI3K/Akt signaling pathway in EC and elaborates on the specific targets and efficacy of TCM in treating EC through intervention in the PI3K/Akt signaling pathway in the past five years. TCM materials and extracts inhibiting the PI3K/Akt signaling pathway in EC include Borneolum， spore powder of Ganoderma lucidum without spore coat， extract of Celastrus orbiculatus， root extract of Taraxacum， and Bruceae Fructus oil emulsion. TCM active ingredients exerting the effect include flavonoids， terpenoids， saponins， phenols， polysaccharides， alkaloids， and other compounds. TCM compound prescriptions with such effect include Qige San， Huqi San， Xuanfu Daizhetang， Tongyoutang and its decomposed prescriptions， Liujunzi Tang， and Xishenzhi Formula. In addition， TCM injections such as Compound Kushen Injection and Kang'ai injection also inhibit the PI3K/Akt signaling pathway in EC. This paper summarizes the role of the PI3K/Akt signaling pathway in EC and the TCM interventions， aiming to provide reference for the research and clinical application of new drugs for EC.

ObjectiveTo investigate the efficacy of sequential tenofovir alafenamide fumarate （TAF） therapy versus the regimen of entecavir （ETV） combined with TAF in chronic hepatitis B （CHB） patients experiencing low-level viremia （LLV） after ETV therapy， as well as their impact on virologic response， liver and renal function， and blood lipid levels. MethodsA total of 217 CHB patients with LLV after ETV treatment who were admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 2020 to December 2023 were enrolled， and according to the treatment regimen， they were divided into TAF group （180 patients receiving sequential TAF therapy） and combined group （37 patients receiving ETV+TAF therapy）. The propensity score matching （PSM） method was used to match the patients at a ratio of 1∶1， and finally 37 patients were included in each group to balance the baseline confounding factors. The two groups were compared in terms of hepatitis B virus DNA （HBV DNA） clearance rate， hepatitis B envelope antigen （HBeAg） clearance rate， liver and renal function parameters （liver stiffness measurement ［LSM］， platelet count ［PLT］， aspartate aminotransferase ［AST］， alanine aminotransferase ［ALT］， and creatinine ［Cr］）， blood lipid levels （total cholesterol ［TC］， triglyceride ［TG］， high-density lipoprotein cholesterol ［HDL-C］， and low-density lipoprotein cholesterol ［LDL-C］）， and the incidence rate of adverse reactions. The independent samples t-test was used for comparison of normally distributed continuous data between two groups， and the paired t-test was used for comparison within each group； the chi-square test was used for comparison of categorical data between groups. ResultsAfter 48 weeks of treatment， compared with the TAF group， the combined group had significantly higher HBV DNA clearance rate （86.49% vs 59.46%， χ²=6.852， P=0.009） and HBeAg clearance rate （59.46% vs 35.14%， χ²=4.391， P=0.036）. After treatment， compared with the TAF group， the combined group had significantly lower levels of LSM （7.01±1.50 kPa vs 7.90±1.68 kPa， t=2.404， P=0.019）， AST （18.02±2.28 U/L vs 21.12±2.85 U/L， t=5.166， P<0.001）， and ALT （19.85±3.86 U/L vs 22.00±3.90 U/L， t=2.383， P=0.020） and significantly higher levels of PLT ［（218.35±42.60）×10⁹/L vs （192.82±44.13）×10⁹/L， t=2.532， P=0.014］ and Cr （70.92±6.54 μmoL/L vs 67.60±6.13 μmoL/L， t=2.253， P=0.027）. After treatment， there was a slight increase in the level of TC in both the TAF group （5.60±0.89 mmol/L vs 5.18±0.85 mmol/L， t=2.076， P=0.041） and the combined group （5.45±0.80 mmol/L vs 5.02±0.83 mmol/L， t=2.269， P=0.026）. There was no significant difference in the incidence rate of adverse reactions between the TAF group and the combined group （21.62% vs 18.92%， χ²=0.084， P=0.772）. ConclusionFor ETV-treated CHB patients experiencing LLV， compared with sequential TAF therapy， the ETV+TAF combined therapy can effectively increase virologic response rate， alleviate liver fibrosis， and improve liver function， whereas sequential TAF therapy has less impact on renal function. Sequential or combined therapy with TAF may induce a slight increase in the level of TC， which should be taken seriously in clinical practice.

Objective:To investigate the effect of monocular form deprivation (MD) during the pre-critical period of visual development on the density and morphology of dendritic spines in mouse primary visual cortex (V1) neurons.Methods:Twenty SPF male C57BL/6J mice with eyes opened on postnatal day 14 (P14) were selected and divided into MD and control groups using a random number table, with 10 mice in each group.The MD group was fed to P18 after 4 days of MD in the right eye, and the control group was raised to P18 under the same feeding conditions.All mice were decapitated after cardiac perfusion, and the sections were stained with the cell membrane fluorescent probe 1, 1′-dioctadecyl-3, 3′, 3′-tetramethylindocarbocyanine perchlorate, and imaged by laser scanning confocal microscopy to observe and compare the differences in density and morphology of dendritic spines in bilateral V1 neurons between the control group and the MD group.This study was approved by the Animal Ethics Committee of Tianjin Medical University (No.TMUaMEC2022004).Results:The total density of dendritic spines in the V1 area on the left side of the control group, the right side of the control group, the left side of the MD group, and the right side of the MD group were (7.57±0.25), (7.42±0.25), (6.54±0.18), and (7.51±0.29)spines/10 μm, respectively, with a statistically significant overall difference ( F=3.818, P<0.05).The total density of dendritic spines in the left V1 area of mice in the MD group was significantly lower than that in the left side of the control group and the right side of the MD group, and the differences were statistically significant (both P<0.05).There was a significant difference in the proportion of the four types of dendritic spines in V1 neurons on both sides between the two groups ( χ2=26.295, P=0.002).There was a significant difference in the proportion of the four types of dendritic spines between the left V1 of the MD group and the left and right V1 of the control group (both P<0.008 3).There was a significant difference in the filopodia-type dendritic spine density in bilateral V1 neurons between the two groups ( F=3.253, P<0.05).Compared with the left V1 area of the control group, the density of filopodia-type dendritic spines in the left V1 area of the MD group decreased significantly, with a statistical significance ( P<0.05).There was no significant difference in the density of thin-type, mushroom-type, and stubby-type dendritic spines in bilateral V1 area neurons between the two groups ( F=1.760, 2.618, 1.749; all P>0.05). Conclusions:MD during the pre-critical period of visual development can cause a decrease in the total density of dendritic spines and significant changes in the compositional proportions in the V1 contralateral to the deprived eye, and is mainly manifested by a decrease in the number of filopodia, suggesting that abnormal visual experience can cause plastic changes in the number and structure of synapses in the visual cortex during the pre-critical period of visual development.

Esophageal squamous cell carcinoma(ESCC)is a common malignant tumor with insidious early symptoms and a poor prognosis.In traditional Chinese medicine(TCM),ESCC is classified as"ye ge."Drawing on clinical experience,we believe that kidney deficiency leads to the deficiency of vital qi and immune dysfunction,providing the foundation for cancerous growth by depleting qi and damaging essence,toxic stasis and stagnation,forming a local hypoxic and acidic microenvironment that promotes tumor invasion,metastasis,and recurrence.Considering the effect of modern comprehensive treatments,the occurrence and development of ESCC are summarized as kidney deficiency being the root cause and toxic stasis being the driving force.The pathogenesis and treatment of ESCC in the preoperative,postoperative,and non-surgical treatment stages are discussed.The pathogenesis of the disease is summarized as follows:preoperatively,toxicity and stasis intertwine,depleting the kidney;postoperatively,the kidney loses its vitality,allowing various pathogenic factors to persist;during non-operative treatment,vital qi and pathogens contend,resulting in entrenched toxicity.During the preoperative neoadjuvant phase,therapy should resolve stasis,eliminate toxins,enhance kidney function,tonify essence,and support the body.During the postoperative adjuvant phase,therapy should strengthen the root and consolidate the foundation while detoxifying and expelling stasis.The non-surgical treatment stage uses"balanced interruption,"targeting tumor progression and metastasis by harmonizing yin and yang,thus preventing recurrence.This article will provide insights into the integrative Chinese-Western management of ESCC.

Objective:To investigate the effect of monocular form deprivation (MD) during the pre-critical period of visual development on the density and morphology of dendritic spines in mouse primary visual cortex (V1) neurons.Methods:Twenty SPF male C57BL/6J mice with eyes opened on postnatal day 14 (P14) were selected and divided into MD and control groups using a random number table, with 10 mice in each group.The MD group was fed to P18 after 4 days of MD in the right eye, and the control group was raised to P18 under the same feeding conditions.All mice were decapitated after cardiac perfusion, and the sections were stained with the cell membrane fluorescent probe 1, 1′-dioctadecyl-3, 3′, 3′-tetramethylindocarbocyanine perchlorate, and imaged by laser scanning confocal microscopy to observe and compare the differences in density and morphology of dendritic spines in bilateral V1 neurons between the control group and the MD group.This study was approved by the Animal Ethics Committee of Tianjin Medical University (No.TMUaMEC2022004).Results:The total density of dendritic spines in the V1 area on the left side of the control group, the right side of the control group, the left side of the MD group, and the right side of the MD group were (7.57±0.25), (7.42±0.25), (6.54±0.18), and (7.51±0.29)spines/10 μm, respectively, with a statistically significant overall difference ( F=3.818, P<0.05).The total density of dendritic spines in the left V1 area of mice in the MD group was significantly lower than that in the left side of the control group and the right side of the MD group, and the differences were statistically significant (both P<0.05).There was a significant difference in the proportion of the four types of dendritic spines in V1 neurons on both sides between the two groups ( χ2=26.295, P=0.002).There was a significant difference in the proportion of the four types of dendritic spines between the left V1 of the MD group and the left and right V1 of the control group (both P<0.008 3).There was a significant difference in the filopodia-type dendritic spine density in bilateral V1 neurons between the two groups ( F=3.253, P<0.05).Compared with the left V1 area of the control group, the density of filopodia-type dendritic spines in the left V1 area of the MD group decreased significantly, with a statistical significance ( P<0.05).There was no significant difference in the density of thin-type, mushroom-type, and stubby-type dendritic spines in bilateral V1 area neurons between the two groups ( F=1.760, 2.618, 1.749; all P>0.05). Conclusions:MD during the pre-critical period of visual development can cause a decrease in the total density of dendritic spines and significant changes in the compositional proportions in the V1 contralateral to the deprived eye, and is mainly manifested by a decrease in the number of filopodia, suggesting that abnormal visual experience can cause plastic changes in the number and structure of synapses in the visual cortex during the pre-critical period of visual development.

Objective:To explore the feasibility, safety, and effectiveness of a novel suture instrument for closure of full thickness defects of the gastric wall under gastroscopy.Methods:Ten pigs were used as experimental animals. Perforation model (30 mm in long diameter) was created in the stomach of each pig. The perforations were then closed by the novel suture instrument under gastroscopy. The completion time and efficacy of each perforation repair were recorded. The pigs were euthanized 14 days after the procedure. The healing condition was observed under gastroscopy. A postmortem examination was performed to observe the abdominal infection and healing condition of perforation. Ascites sample was taken for bacterial culture.The stomach biopsy were taken for histopathologic examination.Results:All gastric perforation models in the 10 pigs were established successfully. Endoscopic closure for the stomach perforation was technically successful in all 10 pigs. The procedure time was 34.10±10.32 minutes. All animals survived. Gastroscopy and necropsy showed that the perforation healed well with local adhesion. One pig developed abdominal infection. Ascites culture were negative in 9 cases, 1 bacterial infection was caused by Arcanobacterium pyogenes and Escherichiacoli. The pathology results showed that the muscular layer of the gastric wall defect in the entire group was well repaired. Conclusion:The novel suture instrument is safe and effective in repairing full-thickness gastric wall defects under ordinary single clamp gastroscopy, providing an experimental basis for further clinical research.

Objective:To investigate the effect of aerobic exercise with acupuncture needles on the learning and memory ability in rats subjected to middle cerebral artery occlusion/reperfusion(MCAO/R)and to explore the underly-ing mechanisms.Method:Male SD rats were randomly divided into four groups:sham,model,aerobic exercise with acupunc-ture needles,and inhibitor groups(n=12 per group).In the sham group,only the left common carotid artery,in-ternal carotid ar tery,and external carotid artery were exposed without inducing ischemia,while the other three groups underwent MCAO/R modeling.To establish an MCAO/R model with reduced NLRP3 expression,rats in the inhibitor group received an intraperitoneal injection of MCC950 60 minutes before modeling.On the first day of post-modeling,the Zea-Longa score and T2 WI were used to screen the MCAO/R rats.From the second day,rats in the aerobic exercise with acupuncture needles and the inhibitor groups were underwent a 14-day intervention.The acupoints were selected for"Shenting"(GV 24)and"Baihui"(GV 20),with sparse waveform at a frequency 2/10Hz and a current intensity of 1-3mA.Simultaneously,the rats performed tread-mill exercise,with speeds of 4m/min(day 1-3),6m/min(day 4-7),and 8m/min(day 8-14)for 30min/day.Afterthe intervention,neurological function was reassessed,and the new object recognition test was used to measure the learning and memory ability,and the pathological changes of the hippocampus were observed by HE staining.The protein expressions of NLRP 3,GSDMD,and Caspase-1 were detected by Western Blot and immunofluorescence,ELISA detected the contents of ILL-1β and IL-18,the expression and localization of IBA 1 and NLRP 3 were detected by double immunofluorescent staining.Result:The hippocampal neurons in the ischemic side of the rats were loosely and disorderly arranged in the model group.Compared to the sham group,the model group showed significantly impaired neurological func-tion and novel object recognition ability(P＜0.01),with significant increased expression of NLRP 3,GSDMD,and Caspase-1(P＜0.01),and elevated ILL-lβ and IL-18 contents(P＜0.01).In addition,IBA 1 and NLRP 3 fluo-rescence expression were enhanced(P＜0.01),and many IBA 1+/NLRP 3+double-positive cells were observed un-der the microscope(P＜0.01).Compared with the model group,the aerobic exercise with acupuncture needles group showed significant improvements in neurological function and the new object recognition index(P＜0.05,P＜0.01),reduced hippocampal pathological injury,decreased expression of NLRP 3,GSDMD,and Caspase-1 d(P＜0.01)and lower IL-lβ and IL-18 levels(P＜0.05);the activation of microglia and the expression of IBA 1,NL-RP 3 and the number of IBA 1+/NLRP 3+double-positive cells decreased(P＜0.01).The inhibitor group demon-strated even greater improvements in neural function and new object recognition performance than the aerobic exercise with acupuncture needles group(P＜0.05,P＜0.01),with further reductions in NLRP 3,GSDMD,Caspase-1 protein expression(P＜0.01)and lower level of IL-1β,IL-18(P＜0.01,P＜0.05);the microglia activation level,the number,arrangement and morphology of nerve cells were closely resembled those in the sham group,and there was minimal NLRP 3 microglia observed under the microscope(P＜0.01).Conclusion:Aerobic exercise with acupuncture needles at"Shenting"(GV 24)and"Baihui"(GV 20)points could improve the learning and memory function in MACO/R rats by inhibiting microglia pyroptosis and activa-tion,thereby reducing neuroinflammation.

Objective:To investigate the effect of aerobic exercise with acupuncture needles on the learning and memory ability in rats subjected to middle cerebral artery occlusion/reperfusion(MCAO/R)and to explore the underly-ing mechanisms.Method:Male SD rats were randomly divided into four groups:sham,model,aerobic exercise with acupunc-ture needles,and inhibitor groups(n=12 per group).In the sham group,only the left common carotid artery,in-ternal carotid ar tery,and external carotid artery were exposed without inducing ischemia,while the other three groups underwent MCAO/R modeling.To establish an MCAO/R model with reduced NLRP3 expression,rats in the inhibitor group received an intraperitoneal injection of MCC950 60 minutes before modeling.On the first day of post-modeling,the Zea-Longa score and T2 WI were used to screen the MCAO/R rats.From the second day,rats in the aerobic exercise with acupuncture needles and the inhibitor groups were underwent a 14-day intervention.The acupoints were selected for"Shenting"(GV 24)and"Baihui"(GV 20),with sparse waveform at a frequency 2/10Hz and a current intensity of 1-3mA.Simultaneously,the rats performed tread-mill exercise,with speeds of 4m/min(day 1-3),6m/min(day 4-7),and 8m/min(day 8-14)for 30min/day.Afterthe intervention,neurological function was reassessed,and the new object recognition test was used to measure the learning and memory ability,and the pathological changes of the hippocampus were observed by HE staining.The protein expressions of NLRP 3,GSDMD,and Caspase-1 were detected by Western Blot and immunofluorescence,ELISA detected the contents of ILL-1β and IL-18,the expression and localization of IBA 1 and NLRP 3 were detected by double immunofluorescent staining.Result:The hippocampal neurons in the ischemic side of the rats were loosely and disorderly arranged in the model group.Compared to the sham group,the model group showed significantly impaired neurological func-tion and novel object recognition ability(P＜0.01),with significant increased expression of NLRP 3,GSDMD,and Caspase-1(P＜0.01),and elevated ILL-lβ and IL-18 contents(P＜0.01).In addition,IBA 1 and NLRP 3 fluo-rescence expression were enhanced(P＜0.01),and many IBA 1+/NLRP 3+double-positive cells were observed un-der the microscope(P＜0.01).Compared with the model group,the aerobic exercise with acupuncture needles group showed significant improvements in neurological function and the new object recognition index(P＜0.05,P＜0.01),reduced hippocampal pathological injury,decreased expression of NLRP 3,GSDMD,and Caspase-1 d(P＜0.01)and lower IL-lβ and IL-18 levels(P＜0.05);the activation of microglia and the expression of IBA 1,NL-RP 3 and the number of IBA 1+/NLRP 3+double-positive cells decreased(P＜0.01).The inhibitor group demon-strated even greater improvements in neural function and new object recognition performance than the aerobic exercise with acupuncture needles group(P＜0.05,P＜0.01),with further reductions in NLRP 3,GSDMD,Caspase-1 protein expression(P＜0.01)and lower level of IL-1β,IL-18(P＜0.01,P＜0.05);the microglia activation level,the number,arrangement and morphology of nerve cells were closely resembled those in the sham group,and there was minimal NLRP 3 microglia observed under the microscope(P＜0.01).Conclusion:Aerobic exercise with acupuncture needles at"Shenting"(GV 24)and"Baihui"(GV 20)points could improve the learning and memory function in MACO/R rats by inhibiting microglia pyroptosis and activa-tion,thereby reducing neuroinflammation.

Children with developmental coordination disorder (DCD) commonly experience difficulties with handwriting.However, there is currently no standardized tool for assessing dysgraphia in this population.Therefore, this paper provides a review of the commonly used handwriting assessment tools both domestically and internationally, as well as their application in individuals with DCD.The aim is to offer a reference to clinical professionals involved in the diagnosis and treatment of DCD in selecting appropriate tools for assessing handwriting difficulties in children.

Esophageal squamous cell carcinoma(ESCC)is a common malignant tumor with insidious early symptoms and a poor prognosis.In traditional Chinese medicine(TCM),ESCC is classified as"ye ge."Drawing on clinical experience,we believe that kidney deficiency leads to the deficiency of vital qi and immune dysfunction,providing the foundation for cancerous growth by depleting qi and damaging essence,toxic stasis and stagnation,forming a local hypoxic and acidic microenvironment that promotes tumor invasion,metastasis,and recurrence.Considering the effect of modern comprehensive treatments,the occurrence and development of ESCC are summarized as kidney deficiency being the root cause and toxic stasis being the driving force.The pathogenesis and treatment of ESCC in the preoperative,postoperative,and non-surgical treatment stages are discussed.The pathogenesis of the disease is summarized as follows:preoperatively,toxicity and stasis intertwine,depleting the kidney;postoperatively,the kidney loses its vitality,allowing various pathogenic factors to persist;during non-operative treatment,vital qi and pathogens contend,resulting in entrenched toxicity.During the preoperative neoadjuvant phase,therapy should resolve stasis,eliminate toxins,enhance kidney function,tonify essence,and support the body.During the postoperative adjuvant phase,therapy should strengthen the root and consolidate the foundation while detoxifying and expelling stasis.The non-surgical treatment stage uses"balanced interruption,"targeting tumor progression and metastasis by harmonizing yin and yang,thus preventing recurrence.This article will provide insights into the integrative Chinese-Western management of ESCC.