[Objective]To summarize the clinical experience of a Master of traditional Chinese medicine(TCM),Professor XIONG Jibai,in treating severe cerebrovascular diseases(CVD)with modified Ditan Decoction combined with Tianma Zhijing Powder based on syndrome differentiation.[Methods]By tracing the historical understanding of severe CVD in both Chinese and western medicine,and summarizing Professor XIONG Jibai's diagnostic and therapeutic system for treating apoplexia from the phlegm-wind perspective by using insect drugs,this study analyzes the formulation principles and synergistic effects of Tianma Zhijing Powder and Ditan Decoction.Using a clinical case of severe CVD as example,it extracted the syndrome differentiation and treatment experience of applying modified Ditan Decoction combined with Tianma Zhijing Powder in managing severe CVD.[Results]Severe CVD falls under the category of apoplexia involving the Zang-Fu organs in TCM.Professor XIONG Jibai attributes this condition to the simultaneous pathogenic effects of phlegm and wind.The treatment requires the use of insect drugs to eliminate phlegm,unblock collaterals and reinforce healthy Qi.The combination of Ditan Decoction and Tianma Zhijing Powder works to dispel wind-phlegm and dredge the meridians and collaterals.These two formulas mutually reinforce each other's effects,enhancing their therapeutic potency.In the clinical case,adding heat-clearing and orifice-opening ingredients helped restore consciousness in comatose patient,demonstrating the favorable clinical efficacy of this approach in treating severe CVD.[Conclusion]Professor XIONG Jibai postulates the theory of internal wind complicated by phlegm and successfully treated patients with severe CVD.Using Ditan Decoction combined with Tianma Zhijing Powder as the core formula,he applies insect drugs to eliminate phlegm,unblock collaterals and reinforce healthy Qi.This case provided a novel approach to overcome therapeutic bottlenecks in severe CVD management,highlight the potential for further exploration of TCM in treating this critical condition.

[Objective]To summarize the clinical experience of a Master of traditional Chinese medicine(TCM),Professor XIONG Jibai,in treating severe cerebrovascular diseases(CVD)with modified Ditan Decoction combined with Tianma Zhijing Powder based on syndrome differentiation.[Methods]By tracing the historical understanding of severe CVD in both Chinese and western medicine,and summarizing Professor XIONG Jibai's diagnostic and therapeutic system for treating apoplexia from the phlegm-wind perspective by using insect drugs,this study analyzes the formulation principles and synergistic effects of Tianma Zhijing Powder and Ditan Decoction.Using a clinical case of severe CVD as example,it extracted the syndrome differentiation and treatment experience of applying modified Ditan Decoction combined with Tianma Zhijing Powder in managing severe CVD.[Results]Severe CVD falls under the category of apoplexia involving the Zang-Fu organs in TCM.Professor XIONG Jibai attributes this condition to the simultaneous pathogenic effects of phlegm and wind.The treatment requires the use of insect drugs to eliminate phlegm,unblock collaterals and reinforce healthy Qi.The combination of Ditan Decoction and Tianma Zhijing Powder works to dispel wind-phlegm and dredge the meridians and collaterals.These two formulas mutually reinforce each other's effects,enhancing their therapeutic potency.In the clinical case,adding heat-clearing and orifice-opening ingredients helped restore consciousness in comatose patient,demonstrating the favorable clinical efficacy of this approach in treating severe CVD.[Conclusion]Professor XIONG Jibai postulates the theory of internal wind complicated by phlegm and successfully treated patients with severe CVD.Using Ditan Decoction combined with Tianma Zhijing Powder as the core formula,he applies insect drugs to eliminate phlegm,unblock collaterals and reinforce healthy Qi.This case provided a novel approach to overcome therapeutic bottlenecks in severe CVD management,highlight the potential for further exploration of TCM in treating this critical condition.

Objective:To evaluate the clinical efficacy and safety of Blinatumomab on the treatment of refractory or relapsed precursor B-cell acute lymphoblastic leukemia (R/R BCP-ALL) in children.Methods:Clinical data of children with R/R BCP-ALL treated with Blinatumomab in the Department of Hematology, Children′s Hospital of Soochow University, from August 2021 to June 2022 were retrospectively analyzed.Children were divided into<45 kg group and ≥45 kg group according to their weight at admission.They were treated with different dosages of Blinatumomab, and bone marrow remission was assessed at about 15 days.Clinical indicators and adverse events during the treatment period were recorded.The rank sum test of two independent samples were used to compare the differences between groups.The Fisher′ s test was used for comparing categorical variables. Results:Among the 16 children with R/R BCP-ALL, 12 cases (75%) achieved complete response (CR) and minimal residual lesion (MRD) turned negative at about 14 days.Among them, 5 out of 9 children with bone marrow primitive naive cell ratio≥0.5 achieved CR, and 7/7 children with bone marrow primitive naive cell ratio<0.5 achieved CR.The peak value of interleukin-6 (IL-6) in children with CR was significantly higher than those without CR ( Z=2.50, P=0.012). Twelve cases achieved CR on bone marrow assessment around day 15, and 3 cases who did not achieve CR remained in remission on day 28, with an efficacy prediction accuracy of 93.8%(15/16). Adverse events included fever, neutropenia, hypokalemia, abnormal liver function, hypocalcemia, edema, rash, hypertension, myocardial damage, abdominal pain, hypotension, and cytokine release syndrome, which were all grade 1.Neurotoxicity and death were not reported. Conclusions:The remission rate of R/R BCP-ALL in children treated with Blinatumomab was high, especially in patients with a low tumor load.The toxicity and adverse events of Blinatumomab treatment are minor and controllable.Day 15 is the optimal time point to evaluate the efficacy of Blinatumomab on children with R/R BCP-ALL, and a higher IL-6 peak can be served as a predictor of its efficacy.

Objective: To review and summarize recent update on preoperative diagnostic criteria, treatment and postoperative follow-up for medullary thyroid carcinoma. Methods: The relevant literatures and guidelines about medullary thyroid carcinoma were analyzed and summarized. Results: In the early stages of the disease radical surgery still dominated. Ultrasound results suggested that prophylactic lateral neck dissection was required for patients with high risk factors or high levels of carcinoembryonic antigen and calcitonin need prophylactic. Early hereditary medullary carcinoma could receive prophylactic thyroidectomy based on RET gene test results. Advanced progressive medullary thyroid carcinoma could be treated with palliative surgery,molecular targeted drugs and chemotherapy. Conclusions The prognosis of medullary thyroid carcinoma is poor and lymph node metastasis is easy to occur early. The extent of initial operation should be enough. Locally advanced or distant metastatic medullary thyroid carcinoma can be treated with palliative surgery,molecular targeted drugs and chemotherapy.

Extrathyroidal extension of thyroid cancer has been an important adverse factor affecting the prognosis of patients. According to the latest NCCN (National Comprehensive Cancer Network) guidelines, extrathyroidal extension is the surgical guide fortotal thyroidectomy in newly diagnosed patients, and its incidence in differentiated thyroid cancer is 5%-34%, belonging to T3-T4 stage.In the eighth edition of thyroid cancer AJCC staging, the T3 stage was first divided into T3a (tumor>4 cm and limited to the thyroid) and T3b (gross extrathyroidal extension invading only strap muscles from a tumor of any size), and the "minimal extrathyroidal extension(tumor invasion intoperithyroidal soft tissue or strap muscle invasion)"of the seventh edition was removed from the T stage and changed to the gross extrathyroidal extension invading only strap muscles, but there is still much controversy. It can be seen that different degrees of "extrathyroidal extension" have significant differences in the survival and prognosis of thyroid cancer. This article reviews the latest research progress of extrathyroidal extension, and discusses the significance and clinical research progress of it.

Thyroid cancer is a common head and neck malignant tumor,it has become a malignant tumor of the highest incidence in young women in China.The treatment of thyroid cancer is a surgery-based comprehensive therapy,and the protection of the parathyroid gland during surgery has always been a major problem for clinicians.The methods for protection of parathyroid glands are in situ preservation or immediate parathyroid autotransplantation according to whether or not the blood supply can be maintained.To identify the parathyroid gland is the key issue of the protection during thryoidectomy.This article reviews the recent progress of the identification and protection of parathyroid glands at home and abroad.

Objective: To investigate the application of virtual reality technology in the preoperative evaluation of complex head and neck carcinoma and he value of virtual reality technology in surgical treatment of head and neck carcinoma. Methods: The image data of eight patients with complex head and neck carcinoma treated from December 2016 to May 2017 was acquired. The data were put into virtual reality system to built the three-dimensional anatomical model of carcinoma and to created the surgical scene. The process of surgery was stimulated by recognizing the relationship between tumor and surrounding important structures. Finally all patients were treated with surgery. And two typical cases were reported. Results: With the help of virtual reality, surgeons could adequately assess the condition of carcinoma and the security of operation and ensured the safety of operations. Conclusions Virtual reality can provide the surgeons with the sensory experience in virtual surgery scenes and achieve the man-computer cooperation and stereoscopic assessment, which will ensure the safety of surgery. Virtual reality has a huge impact on guiding the traditional surgical procedure of head and neck carcinoma.

Objective To evaluate the effect of transitional care intervention on quality of life for patients with chronic obstructive pulmonary disease (COPD). Methods The Cochrane library, PubMed, Embase, Chinese biomedical literature database(CBM), Chinese scientific journals full-text database, Wanfang data were searched up to June 2015 to identify randomized controlled trials(RCTs) comparing continuity of patient care with conventional treatment.The data were analyzed using Revman 5.2 software. Results 26 RCTs involving 2 443 participants were included.The results of Meta-analysis showed continuity of care couldreduce the scores of The COPD Assessment Test [ SMD=-2.24, 95%CI=(-3.52--0.96), P<0.01],and St George′s Respiratory Questionnaire [SMD=-0.26, 95%CI(-0.50--0.02), P≤0.05], and could improve the scores of Chronic Respiratory Disease Questionnaires [SMD=0.46, 95%CI(0.08-0.84), P≤0.05]. Conclusions Transitional care can improve the quality of life of patients with COPD.

This paper reviewed the subjective and objective evaluation tools of sleep disorders, and summarized evaluation indicators of sleep disorders, so as to provide a theoretical support and practical reference for the diagnosis of sleep disorders, intervention and related researches.

Objective To conduct a screening survey of glycophorin (GP) variants and observe the content changes of sialic acid (SA) and total sulfhydryl (SH) groups on the erythrocyte membranes among residents in a tertian malaria hyperendemic area of Guizhou Province.Methods GP variants were detected in the erythrocyte hemolysates of 173 local residents at two villages of Libo County by SDS-PAGE on 10% to 15% gradients gel and Western immunoblotting. Their SA and total SH group contents were estimated in erythrocyte membranes by spectrophotometric methods. 114 healthy subjects in Changsha and 49 individuals at a neighbouring village of the above area showing low morbidity of malaria served as normal and endemic controls respectively.Results Three distinct types of GP variants were found among 19 propositi in this hyperendemic area. The incidence of GP variants was 7.9% (8/101) at Yaolu Village whose population was mainly composed of Yao ethnic group;while that of Buyi ethnic group at Maolan Village was higher (15.3%; 11/72).The erythrocyte membrane contents of SA in residents at both villages exhibited a very significant tendency of decline (P<0.01), whereas those of total SH groups increased prominently in residents of Yaolu Village only (P<0.05).Conclusions The frequency of GP variants in this hyperendemic area does not depend upon the severity of malarial prevalence. The evident reduction of SA contents in the residents may be related to the breaking down of the SA residues on membrane GPs by the invasion of Plasmodium vivax.