Idiopathic pulmonary fibrosis （IPF） is a chronic and fibrotic lethal interstitial lung disease with poor prognosis. It is mainly treated by organ transplantation and administration of chemical drugs， which have poor efficacy and induce side effects， failing to meet the clinical needs. Therefore， it is urgent to develop more safe and effective drugs to treat IPF. Traditional Chinese medicine （TCM） has garnered increasing attention in recent years in the treatment of IPF due to its unique advantages. Increasing studies have shown that TCM has remarkable therapeutic effects on IPF and thus demonstrate broad application prospects. Modern medical research shows that the pathogenesis of IPF can be discussed from inflammation （macrophage polarization）， oxidative stress， epithelial-mesenchymal transition （EMT）， autophagy inhibition and other related signaling pathways， while few studies systematically explain the relationship between the signaling pathways and TCM theory. According to the theory of TCM， lung collateral obstruction is the basic pathogenesis of IPF. Therefore， according to the principle of dredging and replenishing lung collaterals， IPF can be treated with the methods of reinforcing healthy qi and eliminating pathogen， replenishing qi and activating blood， and detoxifying and dredging collaterals， which demonstrate definite curative effect and can effectively relieve clinical symptoms， restore the lung function and blood oxygen partial pressure， improve the quality of life of patients， and reduce adverse reactions. Experimental studies have found that dredging and replenishing lung collaterals have significant effects on IPF inflammation （macrophage polarization）， oxidative stress， EMT， autophagy inhibition and other signaling pathways. Therefore， from the perspective of impediment， this article reviews pathogenesis of IPF， the research progress in TCM treatment of IPF， and the treatment of IPF from active components， single herbs， and compound prescriptions of TCM， with the aim of revealing the scientific connotation of the treatment of IPF from impediment and providing a new theoretical basis for enriching the TCM methods of treating IPF.

Objective To investigate the risk factors for early neurological deterioration(END)in patients with acute minor stroke and vertebrobasilar occlusion who received best medical treatment.Methods A total of 114 patients with acute vertebrobasilar artery occlusion and NIHSS score of＜6 were enrolled from a single-center prospective database within 24 h of symptom onset.END was defined as an increase of≥4 points or a ≥ 2 points increase in any single NIHSS item within 72 h stroke onset and exclusion of intracranial haemorrhage.Multivariate Logistic regression analysis was used to identify risk factors associated with END.Results END occurred in 31 patients(27.2％).The age,baseline systolic blood pressure,proportion of proximal vertebrobasilar artery occlusion and time to peak(Tmax)＞6 s volume of patients in the END group were significantly higher than those in the non-END group(all P＜0.05).Multivariate Logistic regression analysis showed that baseline systolic blood pressure,proximal vertebrobasilar artery occlusion and Tmax＞6 s volume were independent risk factors for END in patients with acute vertebrobasilar artery occlusive minor stroke after receiving optimal medical treatment(all P＜0.05).Conclusion In patients with acute minor stroke and vertebrobasilar occlusion who received best medical treatment,baseline systolic blood pressure,proximal vertebrobasilar occlusion,and Tmax＞6 s volume are independent risk factors of END.

Objective To investigate the risk factors for early neurological deterioration(END)in patients with acute minor stroke and vertebrobasilar occlusion who received best medical treatment.Methods A total of 114 patients with acute vertebrobasilar artery occlusion and NIHSS score of＜6 were enrolled from a single-center prospective database within 24 h of symptom onset.END was defined as an increase of≥4 points or a ≥ 2 points increase in any single NIHSS item within 72 h stroke onset and exclusion of intracranial haemorrhage.Multivariate Logistic regression analysis was used to identify risk factors associated with END.Results END occurred in 31 patients(27.2％).The age,baseline systolic blood pressure,proportion of proximal vertebrobasilar artery occlusion and time to peak(Tmax)＞6 s volume of patients in the END group were significantly higher than those in the non-END group(all P＜0.05).Multivariate Logistic regression analysis showed that baseline systolic blood pressure,proximal vertebrobasilar artery occlusion and Tmax＞6 s volume were independent risk factors for END in patients with acute vertebrobasilar artery occlusive minor stroke after receiving optimal medical treatment(all P＜0.05).Conclusion In patients with acute minor stroke and vertebrobasilar occlusion who received best medical treatment,baseline systolic blood pressure,proximal vertebrobasilar occlusion,and Tmax＞6 s volume are independent risk factors of END.

Objective: To evaluate the usefullness of flexible esophagoscopy and chromoendoscopy with Lugol′s solution in the detection of synchronous esophageal neoplasm in patients with hypopharyngeal squamous cell carcinoma (HSCC). Methods: A retrospective review of 96 cases with HSCC that received surgical treatment from March 2016 to March 2017 was accomplished. In these patients, the site of origin were pyriform sinus (n=75), posterior pharyngeal wall (n=11) and postcricoid (n=10). Esophagoscopy was prospectively performed on all patients before treatment for HSCC. All patients underwent conventional white-light endoscopic examination with Lugol chromoendoscopy and narrow band image. Suspicious areas of narrow band image or Lugol-voiding lesions were observed and biopsied. The treatment strategy of primary HSCC was modified according to the presence of synchronous esophageal squamous cell neoplasms by a multidisciplinary approach. Results: Ninety-six patients were enrolled (age ranging from 37-80 years). All patients did not have previous treatment.Histopathological analysis revealed middle to high-grade dysplasia in 5 cases, Tis cancer in 5 cases, cancer in 16 cases and inflammation or normal findings in the others. Four cases were treated with endoscopic submucosal dissection before hypopharygeal surgery, 3 cases with lower esophageal cancers were treated with gastric pull-up combined with free jejunal flap after total circumferential pharyngolaryngectomy (TCPL) and certical esophagectomy, and 14 cases were treated with TCPL, total esophagectomy and gastric pull-up. Conclusions Esophagoscopy is a feasible and justified procedure in HSCC cases as it enhances the detection of premalignant lesion or second primary cancer. Routine esophagoscopy for detecting synchronous second primary tumor should be recommended for patients with HSCC. The treatment strategy for primary HSCC is modified according to the presence of synchronous second primary tumor.

Objective: To investigate the key factors influencing the prognosis of hypopharyngeal carcinoma and the therapeutic methods improving the efficacy of treatments for hypopharyngeal carcinoma. Methods: Two hundred and sixty-four cases of hypopharyngeal squamous cell carcinoma treated from May 2010 to May 2015 were analyzed retrospectively. There were 211 cases of pyriform sinus carcinoma, 37 cases of posterior pharyngeal wall carcinoma, and 16 cases of postcricoid carcinoma. According to UICC 2002 criteria, 2 cases were for stage Ⅰ, 14 for stage Ⅱ, 32 for stage Ⅲ and 216 for stage Ⅳ. Postoperative circumferential defects existed in 112 (42.4%) cases, and 86 of them were reconstructed with free jejunum transplantation. Among all cases, 54 patients (20.5%) had the preservation of laryngeal functions after surgery and 210 patients (79.5%) with total laryngectomy; 238 cases (90.2%) underwent bilateral cervical lymph node dissection and 203 patients received posterior pharyngeal lymph node exploration and dissection, with positive metastases for posterior pharyngeal lymph nodes in 36 cases (17.7%). Eight cases with cervical lymph node metastasis extensively involving the soft tissue, prevertebral fascia or encases carotid artery received preoperative radiotherapy of 50 Gy. After surgery 13 patients received concurrent radiotherapy and chemotherapy, 337 underwent adjuvant radiotherapy with a dose of 50-60 Gy each, and 14 patients did not receive radiotherapy or did not completed their radiotherapy programs. SPSS 13.0 saftware was used to analyze the data. Results: All patients were followed up for more than 2 years. With Kaplan-Meier method, the 2-, 3- and 5-years survival rates were 69.6%, 62.8% and 51.3%, respectively. There were significant differences in 3-year survival rates between T1-2 group (75.5%) and T3-4 group (59.2%) (χ²=4.282 P=0.039), N0 group (81.6%) and N+ group (58.2%) (χ²=6.802 P=0.009), laryngeal functions preserved (81.8%) and unpreserved group (58.9%) (χ²=5.314 P=0.021). Multivariate Logistic regression analysis showed that cervical lymph node metastasis was an independent prognostic factor (P=0.027). The success rate of free jejunum transplantation was 98.8%. Local recurrence, cervical lymph node recurrence, second primary cancer, and distant metastasis accounted respectively for 11.2%, 18.8%, 12.5% and 45.0% of death cases. Conclusions The prognosis-associated factors for hypopharyngeal carcinoma should be taken into account, including the evaluation of the carcinogenesis of the mucosal area, early screening of premalignant lesion or second primary cancer in the esophagus and dissection of the posterior pharyngeal lymph nodes, which will help to improve the local control rate and recent survival rate in patients with hypopharyngeal cancer.

Objective: investigate the incidence of retropharyngeal lymph node (RPLN) metastasis and the risk factors for RPLN metastasis in hypopharyngeal cancer, and the relationship of planned dissection of the RPLN with the survival and tumor control rates in patients with hypopharyngeal cancer. Methods: A total of 203 patients with hypopharyngeal squamous cell carcinoma who underwent radical surgery as initial treatment from February 2011 to July 2015 were analyzed retrospectively. There were 167 cases of pyriform sinus carcinoma, 23 cases of posterior pharyngeal wall carcinoma, and 13 cases of postcricoid carcinoma. Results: The incidence of RPLN metastasis in HPC was 17.7%, with a highest rate of 43.5% in pharyngeal wall carcinoma. The incidence of RPLN metastasis in T3-4 pyriform sinus carcinoma was 18.3%, which significantly higher than 2.8% in T1-2 cases(χ²=5.360, P=0.020). The rate of RPLN metastasis was 23.8% in N2b-3 and 8.6% in N0-2a, with a statistically significant difference(χ²=7.637, P=0.006). There was no statistically significant difference in overall survival rates between patients with and without RPLN metastasis(P>0.05). Data were analyzed by SPSS 13.0 software. Conclusions RPLN metastasis is not rare in hypopharyngeal carcinoma. Planned dissection of the RPLN should be performed with the initial surgery in patients with advanced hypopharyngeal cancer, especially posterior pharyngeal wall carcinoma, T3-4 pyriform sinus carcinoma and staged N2b-3 disease, which can reduce the regional recurrence rate and provided with a better prognosis.

Objective To report our experience in reconstruction with free jejunal flap for circumferential defect following resection of hypopharygeal and cervical esophageal carcinoma.Methods A retrospective analysis was conducted to evaluate the outcomes of reconstruction with free jejunal flaps for circumferential defects in 103 patients treated from Aug 2008 to Mar 2015.Among them,84 were hypopharyngeal carcinoma and 19 were cervical esophageal carcinoma;31 patients had total pharyngolaryngectomy,70 had total pharyngolaryngectomy and cervical esophagectomy and 2 had laryngeal preservation.All patients underwent bilateral neck dissection and 84 underwent retropharyngeal lymph node dissection.Results The 3 year overall survival rate was 51.6％ and disease-specific survival rate was 50％ The 5 year overall survival rate was 39.1％.No in-hospital death,one patient had unsalvageable flap failure and underwent second reconstruction with free jejunal flap.The success rate for the free jejunal flaps was 99％ (102/103).Pharyngocutanous fistula occurred in 3 patients and all healed with conservative treatment.Satisfactory oral intake was achieved in all patients.Conclusions Oncological and functional outcomes of reconstruction with free jejunal flap for circumferential defects of hypopharynx and cervical esophagus were satisfying.Multidisciplinary cooperation is helpful to improve surgical success rate.Free jejunal flap is an ideal method for reconstruction of circumferential hypopharyngeal and cervical esophageal defects after removal of tumor.

Objective To analyze the diagnosis and treatment of intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history ,in order to raise awareness .Methods Clinical data of 23 intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history were retrospectively analyzed.The clinical manifestations ,type,and risk factors were analyzed .And its diagnosis and prevention was dis-cussed.Results 23 patients were caused by intestinal blood circulation disorders ,in which there were 11 cases small intestine mesentery hernia ,2 cases duodenal hernia ,2 cases pericecal hernia ,3 cases omentum hernia ,1 case obturator hernia,2 cases congenital dysplasia and intestinal mesenteric torsion induced small hernia ,2 cases formation of intra-abdominal pressure alone belted intestine ,8 cases of intestinal necrosis .22 patients were cured after surgery ,1 case died,12 cases had postoperative complications .The incidence rate of postoperative complications of patients with in-testinal necrosis was 59.3%( wound infection 37.1%, pneumonia 22.2%), which was significantly higher than 11.8%of patients without intestinal necrosis (wound infection 5.9%,pneumonia 5.9%)(χ2 =3.861,3.861,all P<0.05).Conclusion The intestinal obstruction caused by intra-abdominal hernia with no abdominal surgery history is closed loop obstruction , preoperative diagnosis is difficult , with the rapid progression of the disease , and intestinal strangulation ,intestinal necrosis can occur in the short term whithout timely surgical treatment .Therefore ,early diagno-sis and prompt surgical treatment is the key to the diagnosis and treatment of intestinal obstruction caused by intra -ab-dominal hernia with no abdominal surgery history .

Objective To investigate the efficacy of surgery followed by adjuvant radiotherapy and the prognostic factors affecting the results of treatment in hypopharyngeal carcinoma.Methods A retrospective review of 149 patients with hypopharyngeal carcinoma that received surgical treatment from Jun 2003 to Jun 2010 was accomplished.In the 149 patients,the site of origin were pyriform sinus (n =121),posterior pharyngeal wall (n =21) and postcricoid (n =7).According to UICC 2002 criteria,there were 3 in stage Ⅰ,15 in stage Ⅱ,29 in stage Ⅲ and 102 in stage Ⅳ.Surgical methods for primary tumor were:pyriform sinus resection or posterior pharyngeal wall resection in 22 cases,partial pharyngectomy and partial laryngectomy in 29 cases,partial pharyngectomy and total laryngectomy in 67 cases,total pharyngectomy and total laryngectomy in 16 cases,total pharyngolaryngectomy and partial esophagus resection in 12 cases,and total esophagus resection in 3 cases.All the patients received elective and/or radical neck dissection.Unilateral or bilateral thyroid lobectomy was performed in 98 cases.Eighty-seven patients received intensity modulation radiated therapy (IMRT) postoperatively in the cancer center of Provincial Hospital Affiliated to Shandong University.Individualized adjustment of the radiation field was made according to the surgical condition.Forty-nine cases received radiotherapy in other hospitals (dose 50-70 Gy).Laryngeal function was restored in 51 patients (34.2％).The risk clinicopathological factors of survival and the causes of death were analyzed.Results The survival rate was calculated with Kaplan-Meier method.The overall 3-and 5-year survival rates were 47.7％ and 38.7％,respectively.There were no significant differences in 3-year survival between T1-2 and T3-4 groups,N0 and N + groups,stage Ⅰ-Ⅱ and Ⅲ-Ⅳ groups,laryngeal function preserved and unpreserved groups.The overall 3 years survival rate of patients received surgery and adjuvant radiotherapy was higher than those just received surgery alone (x2 =6.851,P ＜ 0.05).The 3-year survival rate in patients treated in comprehensive treatment group has showed a good trend,although still no statistical significance (x2 =0.176,P ＞ 0.05).The cause of death in 86 patients,including regional lymph nodes recurrence in 25 cases (29.1％).Of them,one was stoma recurrence and 9 were retropharyngeal lymph nodes metastasis; distant metastasis in 19 cases (22.1％) ; local recurrence in 13 cases,local or regional recurrence with distant metastasis in 8 cases (9.3％),and second primary cancer in 6 cases (7.0％).Conclusions The overall prognosis of hypopharyngeal carcinoma was poor and dismal.In accordance with specific conditions of surgery,active adjustment of the personalized protocol of IMRT was the key of improving the efficacy of hypopharyngeal carcinoma.

Objective To investigate the necessity and feasibility of planned dissection of the retropharyngeal lymph nodes (RPLN) in advanced hypopharyngeal cancer.Methods Between February 2011 and December 2012,54 patients with advanced hypopharyngeal cancer accepted planned dissection of the RPLN during primary surgery.There were 45 cases of pyriform sinus carcinoma,5 cases of posterior pharyngeal wall carcinoma,and 4 cases of postcricoid carcinoma.All patients underwent surgery and postoperative adjuvant radiotherapy,meanwhile bilateral neck dissection and RPLN dissection were performed.All patients received preoperative CT scanning (with contrast).The results of the radiographic assessment were compared with the postoperative pathologic findings respectively.Results RPLN were confirmed positive by pathology in 13 cases,and negative in another 43 cases.For the entire treatment group,metastasis to the RPLN was confirmed hispathologically in 12 patients (22.2％).Eight patients were pyriform sinus carcinoma,4 were posterior pharyngeal wall carcinoma.Among them,seven patients were diagnosed as RPLN metastasis by CT imaging and another 5 patients were not confirmed.The overall accuracy for the radiologist's interpretation was 79.6％,the sensitivity was 58.3％,and the specificity was found to be 85.7％.Eleven patients were N2-3 and 6 patients were N2c.No RPLN metastasis or recurrence was found during more than one year follow-up period.Conclusions It is not rare for the RPLN metastasis in patients with advanced hypopharyngeal carcinoma.CT imaging is not effective in determining the early presence of RPLN metastasis.The planned dissection of the RPLN is highly recommended during the initial surgery of hypopharyngeal cancer,especially in posterior pharyngeal wall carcinoma,T3-4 pyriform sinus carcinoma and staged N2-3 cases.