[Objective]To summarize Professor GAO Xiangfu's experience in treating chronic kidney disease with drug pairs and triangular drugs.[Methods]By following the Professor during clinical consultations,organizing medical cases and reviewing literature,this paper summarized Professor GAO's understanding of the pathogenesis and the characteristics of diagnosis and treatment of chronic kidney disease,and the composition,compatibility principles,clinical applications,common doses,and compatibility significance of Professor GAO's commonly using drug pairs and triangular drugs in treatment chronic kidney disease and a medical case was attached for evidence.[Results]Professor GAO believes that the pathological condition of chronic kidney disease is deficient in origin and excess in superficiality.The core pathogenesis of disease progression is characterized by"vital Qi is deficient and toxins are hiding,essence and blood are leaking,vital Qi is attenuating and toxins are enhancing".The deficiency of vital Qi is mainly manifested as deficiency of the spleen and kidney,while the hidden toxins are mainly turbid toxins,blood stasis toxins and heat toxins.In treatment,the priorities should be put on the origin and the superficiality of the pathogenesis,and a case being acute or chronic should be distinguished first,following the principle of treatment that"treating acute cases as the emerging diseases and treating the chronic cases as the primary disease".For acute progressive cases of this disease,drug pairs for eliminating hidden toxins are commonly combined with classic prescriptions.For chronic protracted cases,drug pairs are often used to formulate prescriptions directly.Particularly,Professor GAO commonly uses"Astragalus membranaceus-Angelica sinensis""Astragalus membranaceus-Atractylodes macrocephala"and"Astragalus membranaceus-Cimicifuga foetida-Bupleurum chinense"are used to tonify spleen Qi and invigorate middle-Jiao;he uses"Radix rehmanniae-Dioscorea opposita-Poria cocos""Herba epimedii-Cistanche deserticola"to nourish kidney Yin and tonify kidney Yang,uses"Herba plantaginis-Rheum officinale""Salvia miltiorrhiza-Centella asiatica"to eliminate turbid and blood stasis,and clear stagnated heat,and uses"Rhizoma imperatae-Agrimonia pilosa""Rosa laevigata-Semen euryales"to calm the blood collaterals and control essence.In the attached medical case,a patient with chronic kidney disease was treated with a main formula consisting of five drug pairs including"Astragalus membranaceus-Angelica sinensis""Radix rehmanniae-Dioscorea opposita-Poria cocos""Herba plantaginis-Rheum officinale""Salvia miltiorrhiza-Centella asiatica"and"Rhizoma imperatae-Agrimonia pilosa",which was adjusted according to the symptoms,and ultimately achieved good results.[Conclusion]Professor GAO's approach to treating chronic kidney disease with drug pairs and triangular drugs is characterized by mild medication,hierarchical compatibility and remarkable efficacy,which is worth summarizing and promoting.

Objective:To explore the characteristics and evolutionary features of cognitive impairment and clinical transformation in early-stage Parkinson′s disease (PD) patients.Methods:Based on the cohort of patients with primary unmedicated PD admitted to the Parkinson′s Specialized Outpatient Clinic of Affiliated Brain Hospital of Nanjing Medical University from November 2018 to July 2022, follow-up was conducted for PD patients who completed the baseline assessment and had a follow-up time of 1.5 years or more, and a total of 87 patients finally completed the follow-up and were included in the study. At follow-up, the 87 patients were divided into a cognitively impaired group ( n=36) and a cognitively normal group ( n=51) according to the norm proposed by Professor Jia Jianping and colleagues in 2011 for the Chinese elderly population. Differences in baseline clinical characteristics between the 2 groups were compared, and binary Logistic regression analysis was used to explore risk factors for cognitive impairment in PD patients. In addition, transformed grouping according to cognitive assessment results at baseline and follow-up was used to compare differences in patients′ baseline clinical characteristics among the 3 groups: a reversal group [Parkinson′s disease-mild cognitive impairment (PD-MCI), reverting to Parkinson′s disease-cognitively normal (PD-CN); n=15], a non-reversal group (persistent PD-MCI; n=24), and a stable group (stable PD-CN; n=36). Results:Cognitive reversal occurred at follow-up in 36.6% (15/41) of patients with cognitive impairment at baseline, and 21.7% (10/46) of patients with normal cognition at baseline had cognitive impairment at follow-up. At the end of the follow-up, the 87 patients with PD had higher Unified Parkinson′s Disease Rating Scale Ⅱ (UPDRS-II) scores [8 (6, 11)], Unified Parkinson′s Disease Rating Scale Ⅲ (UPDRS-Ⅲ) scores [23 (16, 30)], and Hoehn-Yahr stages [2.0 (1.5, 2.5)] than those at baseline [7(4, 10), 19(14, 25), 1.5(1.0, 2.0)]. The differences were statistically significant ( Z=-2.498, P=0.012; Z=-3.039, P=0.002; Z=-4.436, P<0.001). The cognitively impaired group had lower Montreal Cognitive Assessment scores [22.00(19.00, 23.75)] and fewer years of education [9.00(8.00, 11.75) years] but higher Parkinson′s Disease Non-Motor Symptoms Questionnaire (PD-NMSQ) scores [8.00(5.25, 12.00)] than the cognitively normal group [25.00(24.00, 27.00), 12.00(9.00, 15.00) years, 6.00(3.00, 8.00)], and the differences were statistically significant ( Z=-4.764, P<0.001; Z=-3.016, P=0.003; Z=-3.281, P=0.001). Multivariate Logistic regression showed that years of education ( OR=0.829, 95%CI 0.715-0.960, P=0.012) and PD-NMSQ scores ( OR=1.200, 95%CI 1.040-1.384, P=0.012) were independent predictors of cognitive impairment in patients with PD. There were statistically significant differences among the reversal, non-reversal, and stable groups in years of education ( F=5.366, P=0.010), PD-NMSQ scores ( H=10.795, P=0.005), and UPDRS-Ⅱ scores ( H=6.957, P=0.031). Pairwise comparisons showed lower PD-NMSQ scores [4.00(3.00, 7.00) vs 8.00(6.25, 12.75); Z=-2.989, P=0.003] and lower UPDRS-Ⅱ scores [6.00(3.00, 6.00) vs 7.00(6.00, 10.00); Z=-2.756, P=0.006] in the reversal group than in the non-reversal group, indicating better baseline quality of life in cognitive reversal patients. Conclusions:Low educational level and severe non-motor symptoms were risk factors predicting cognitive impairment in PD patients. Conversely, mild non-motor symptoms with high quality of life (lower UPDRS-Ⅱ scores) were important factors for cognitive reversal.

[Objective]To summarize Professor GAO Xiangfu's experience in treating chronic kidney disease with drug pairs and triangular drugs.[Methods]By following the Professor during clinical consultations,organizing medical cases and reviewing literature,this paper summarized Professor GAO's understanding of the pathogenesis and the characteristics of diagnosis and treatment of chronic kidney disease,and the composition,compatibility principles,clinical applications,common doses,and compatibility significance of Professor GAO's commonly using drug pairs and triangular drugs in treatment chronic kidney disease and a medical case was attached for evidence.[Results]Professor GAO believes that the pathological condition of chronic kidney disease is deficient in origin and excess in superficiality.The core pathogenesis of disease progression is characterized by"vital Qi is deficient and toxins are hiding,essence and blood are leaking,vital Qi is attenuating and toxins are enhancing".The deficiency of vital Qi is mainly manifested as deficiency of the spleen and kidney,while the hidden toxins are mainly turbid toxins,blood stasis toxins and heat toxins.In treatment,the priorities should be put on the origin and the superficiality of the pathogenesis,and a case being acute or chronic should be distinguished first,following the principle of treatment that"treating acute cases as the emerging diseases and treating the chronic cases as the primary disease".For acute progressive cases of this disease,drug pairs for eliminating hidden toxins are commonly combined with classic prescriptions.For chronic protracted cases,drug pairs are often used to formulate prescriptions directly.Particularly,Professor GAO commonly uses"Astragalus membranaceus-Angelica sinensis""Astragalus membranaceus-Atractylodes macrocephala"and"Astragalus membranaceus-Cimicifuga foetida-Bupleurum chinense"are used to tonify spleen Qi and invigorate middle-Jiao;he uses"Radix rehmanniae-Dioscorea opposita-Poria cocos""Herba epimedii-Cistanche deserticola"to nourish kidney Yin and tonify kidney Yang,uses"Herba plantaginis-Rheum officinale""Salvia miltiorrhiza-Centella asiatica"to eliminate turbid and blood stasis,and clear stagnated heat,and uses"Rhizoma imperatae-Agrimonia pilosa""Rosa laevigata-Semen euryales"to calm the blood collaterals and control essence.In the attached medical case,a patient with chronic kidney disease was treated with a main formula consisting of five drug pairs including"Astragalus membranaceus-Angelica sinensis""Radix rehmanniae-Dioscorea opposita-Poria cocos""Herba plantaginis-Rheum officinale""Salvia miltiorrhiza-Centella asiatica"and"Rhizoma imperatae-Agrimonia pilosa",which was adjusted according to the symptoms,and ultimately achieved good results.[Conclusion]Professor GAO's approach to treating chronic kidney disease with drug pairs and triangular drugs is characterized by mild medication,hierarchical compatibility and remarkable efficacy,which is worth summarizing and promoting.

Objective:To explore the characteristics and evolutionary features of cognitive impairment and clinical transformation in early-stage Parkinson′s disease (PD) patients.Methods:Based on the cohort of patients with primary unmedicated PD admitted to the Parkinson′s Specialized Outpatient Clinic of Affiliated Brain Hospital of Nanjing Medical University from November 2018 to July 2022, follow-up was conducted for PD patients who completed the baseline assessment and had a follow-up time of 1.5 years or more, and a total of 87 patients finally completed the follow-up and were included in the study. At follow-up, the 87 patients were divided into a cognitively impaired group ( n=36) and a cognitively normal group ( n=51) according to the norm proposed by Professor Jia Jianping and colleagues in 2011 for the Chinese elderly population. Differences in baseline clinical characteristics between the 2 groups were compared, and binary Logistic regression analysis was used to explore risk factors for cognitive impairment in PD patients. In addition, transformed grouping according to cognitive assessment results at baseline and follow-up was used to compare differences in patients′ baseline clinical characteristics among the 3 groups: a reversal group [Parkinson′s disease-mild cognitive impairment (PD-MCI), reverting to Parkinson′s disease-cognitively normal (PD-CN); n=15], a non-reversal group (persistent PD-MCI; n=24), and a stable group (stable PD-CN; n=36). Results:Cognitive reversal occurred at follow-up in 36.6% (15/41) of patients with cognitive impairment at baseline, and 21.7% (10/46) of patients with normal cognition at baseline had cognitive impairment at follow-up. At the end of the follow-up, the 87 patients with PD had higher Unified Parkinson′s Disease Rating Scale Ⅱ (UPDRS-II) scores [8 (6, 11)], Unified Parkinson′s Disease Rating Scale Ⅲ (UPDRS-Ⅲ) scores [23 (16, 30)], and Hoehn-Yahr stages [2.0 (1.5, 2.5)] than those at baseline [7(4, 10), 19(14, 25), 1.5(1.0, 2.0)]. The differences were statistically significant ( Z=-2.498, P=0.012; Z=-3.039, P=0.002; Z=-4.436, P<0.001). The cognitively impaired group had lower Montreal Cognitive Assessment scores [22.00(19.00, 23.75)] and fewer years of education [9.00(8.00, 11.75) years] but higher Parkinson′s Disease Non-Motor Symptoms Questionnaire (PD-NMSQ) scores [8.00(5.25, 12.00)] than the cognitively normal group [25.00(24.00, 27.00), 12.00(9.00, 15.00) years, 6.00(3.00, 8.00)], and the differences were statistically significant ( Z=-4.764, P<0.001; Z=-3.016, P=0.003; Z=-3.281, P=0.001). Multivariate Logistic regression showed that years of education ( OR=0.829, 95%CI 0.715-0.960, P=0.012) and PD-NMSQ scores ( OR=1.200, 95%CI 1.040-1.384, P=0.012) were independent predictors of cognitive impairment in patients with PD. There were statistically significant differences among the reversal, non-reversal, and stable groups in years of education ( F=5.366, P=0.010), PD-NMSQ scores ( H=10.795, P=0.005), and UPDRS-Ⅱ scores ( H=6.957, P=0.031). Pairwise comparisons showed lower PD-NMSQ scores [4.00(3.00, 7.00) vs 8.00(6.25, 12.75); Z=-2.989, P=0.003] and lower UPDRS-Ⅱ scores [6.00(3.00, 6.00) vs 7.00(6.00, 10.00); Z=-2.756, P=0.006] in the reversal group than in the non-reversal group, indicating better baseline quality of life in cognitive reversal patients. Conclusions:Low educational level and severe non-motor symptoms were risk factors predicting cognitive impairment in PD patients. Conversely, mild non-motor symptoms with high quality of life (lower UPDRS-Ⅱ scores) were important factors for cognitive reversal.

The technical combination of artificial intelligence (AI) and thoracic surgery is increasingly close, especially in the field of image recognition and pathology diagnosis. Additionally, robotic surgery, as a representative of high-end technology in minimally invasive surgery is flourishing. What progress has been or will be made in robotic surgery in the era of AI? This article aims to summarize the application status of AI in thoracic surgery and progress in robotic surgery, and looks ahead the future.

Lung cancer is the one of the malignant tumor of the highest morbidity and mortality over the world, and non-small cell lung cancer (NSCLC) makes up about 80%. Nowadays, molecular targeted therapy has been the first-line treatment for NSCLC. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are increasingly used in the clinical treatment, but the EGFR-TKIs acquired resistance becomes the bottleneck of continuation of EGFR-TKIs therapy. Epithelial-mesenchymal transition (EMT) is a biological phenomenon in which epithelial cells are transformed into mesenchymal cells. EMT promoted metastasis, invasion of lung cancer and conferred characteristic of stem cell on cancer cells. Meanwhile, EMT is one of an important cause of EGFR-TKIs resistance in NSCLC. The recent studies have found that resistant cells restored the sensitivity to EGFR-TKIs by reversing EMT which suggested that the target of EMT may contribute to inhibit or even reverse the resistance of EGFR-TKIs. Here we make a review about research progress of EMT in EGFR-TKIs resistance in NSCLC.
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Animals ; Antineoplastic Agents ; administration & dosage ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; genetics ; metabolism ; physiopathology ; Drug Resistance, Neoplasm ; Epithelial-Mesenchymal Transition ; drug effects ; ErbB Receptors ; antagonists & inhibitors ; genetics ; metabolism ; Humans ; Lung Neoplasms ; drug therapy ; genetics ; metabolism ; physiopathology ; Protein Kinase Inhibitors ; administration & dosage

OBJECTIVETo analyze the core acupoints and compatibility of electroacupuncture (EA) for simple obesity based on complex network technique, and to explore the usage of EA waveform.

METHODSThe clinical research literature regarding EA for simple obesity published from January of 1980 to June of 2016 were searched in PubMed, CNKI, , VIP, CBM and TCM online database to establish a prescription database of EA for simple obesity. The Matlab2014a software was used to perform the center analysis and cluster analysis, and the analysis of core points and compatibility were conducted. Gephi 9.1 software was used to demonstrate the complex network diagram to further analyze the usage of EA waveform.

RESULTSTotally 238 prescriptions were obtained. The selection of acupoints at -meridians were equally important with acupoints at -meridians. The meridians with highest core degree were stomach meridian, conception vessel and spleen meridian. The acupoints with highest core degree were Sanyinjiao (SP 6), Tianshu (ST 25) and Zusanli (ST 36). The cluster analysis indicated three acupoint clusters, including the key-acupoint cluster, syndrome-acupoint cluster, and -point cluster; it was revealed Tianshu (ST 25) and Zhongwan (CV 12) had the highest intensity of compatibility. The sparse-dense wave was mostly used in EA for simple obesity, followed by continuous wave, indicating both sparse-dense wave and continuous wave had high clinical application value.

CONCLUSIONThe acupoints of EA for simple obesity are mainly in stomach meridian, conception vessel and spleen meridian; sparse-dense wave is mostly used, followed by continuous wave.