ObjectiveTo investigate the clinical value of serum creatinine-to-cystatin C ratio （CCR） in evaluating the prognosis of hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF）. MethodsA retrospective analysis was performed for the clinical data of 130 patients with HBV-ACLF （treatment group） who were hospitalized in Department of Infectious Diseases， The First Affiliated Hospital of Soochow University， from January 2021 to November 2022. According to the treatment outcome， they were divided into survival group with 87 patients and death group with 43 patients； according to the presence or absence of infection， they were divided into infection group with 37 patients and non-infection group with 93 patients. A total of 30 individuals who underwent physical examination during the same period of time were enrolled as control group. Routine blood test results were collected on the day of admission， including white blood cell count， platelet count， neutrophil count， and lymphocyte count； serum creatinine， cystatin C， serum albumin （Alb）， and prothrombin time （PT） were observed on the day of admission and on days 5， 10， and 15 of hospitalization， and related indicators were calculated， including CCR， neutrophil-to-lymphocyte ratio （NLR）， platelet-to-lymphocyte ratio （PLR）， prognostic nutritional index （PNI）， CCR5 （CCR on day 5 after admission）， ΔCCR5 （CCR on day 5 after admission minus CCR on the day of admission）， CCR10 （CCR on day 10 after admission）， ΔCCR10 （CCR on day 10 after admission minus CCR on day 5 after admission）， CCR15 （CCR on day 15 after admission）， and ΔCCR15 （CCR on day 15 after admission minus CCR on day 10 after admission）. The above indicators were compared between the survival group and the death group and between the infection group and the non-infection group. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups. The univariate and multivariate logistic regression analyses were used to investigate the influencing factors for disease prognosis； the receiver operating characteristic （ROC） curve was used to assess the value of CCR in predicting HBV-ACLF death events， and the DeLong test was used for comparison of the area under the ROC curve （AUC）. ResultsThere were significant differences in CCR， NLR， PNI， PT， and Alb at baseline between the treatment group and the healthy control group （all P<0.001）， and there were significant differences in CCR， NLR， and PT between the survival group and the death group on the day of admission （all P<0.05）. Among the 130 patients with HBV-ACLF， there were 25 in the precancerous stage， 48 in the early stage， 32 in the intermediate stage， and 25 in the advanced stage， and there were significant differences in baseline CCR， PLR， and PT between the patients in different stages of HBV-ACLF （all P<0.05）. There were significant differences in ΔCCR5 and NLR between the infection group and the non-infection group （P<0.05）， and there were significant differences in ΔCCR5， CCR10， and CCR15 between the survival group and the death group （all P<0.05）. The multivariate logistic regression analysis showed that ΔCCR5 （odds ratio ［OR］=1.175， 95% confidence interval ［CI］： 1.098‍ — ‍1.256， P<0.001）， NLR （OR=0.921， 95%CI： 0.880‍ — ‍0.964， P<0.001）， and PT （OR=0.921， 95%CI： 0.873‍ — ‍0.973， P=0.003） were independent influencing factors for the prognosis of HBV-ACLF patients. ΔCCR5 had an AUC of 0.774， a sensitivity of 0.687， and a specificity of 0.757， and the AUC of ΔCCR5+PT+NLR was 0.824， which was significantly higher than the AUC of ΔCCR5， NLR， or PT alone （all P<0.05）. ConclusionΔCCR5， NLR， and PT can reflect the condition and prognosis of patients with HBV-ACLF and are independent predictive indicators for death events in patients with HBV-ACLF. The combination ofΔCCR5， PT， and NLR has the best predictive efficiency.

【Objective】 To identify the best surgical treatment for patients with calculous pyonephrosis by evaluating the clinical effectiveness of percutaneous nephrolithotripsy (PCNL) in stageⅠ, percutaneous nephrostomy (PCN) in stageⅠ, and percutaneous nephrolithotripsy in stageⅡ. 【Methods】 For publications published between Jan.2012 and Oct.2022, we thoroughly examined the databases of PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, Wanfang, and VIP.We then chosed the literature based on the inclusion and exclusion criteria.After data were retrieved and literature quality was assessed, Review Manager software (RevMan 5.4.3, Cochrane Collaboration, Oxford, UK) was utilized to Meta-analysis. 【Results】 Out of 688 participants across 105 researches, we chosed 11 trials.Among them, 341 patients received both stageⅠPCN and stage ⅡPCNL (hereinafter referred to as phase ⅡPCNL), while 347 patients received stageⅠPCNL.According to the results of the Meta-analysis, there was no discernible difference between stage Ⅰ PCNL and stage Ⅱ PCNL in terms of stone clearance rate (P=0.95), operation duration (P=0.48), postoperative septic shock (P=0.36), or perirenal effusion infection (P=0.27).There were significant differences between stage Ⅰ PCNL and stage Ⅱ PCNL in fever (P=0.03), indwelling nephrostomy tube time (P=0.01), hospitalization costs (P=0.01), hospitalization time (P=0.01), and postoperative hospitalization time (P=0.02).The following two regimens were comparable in terms of stone clearance rate, operating time, postoperative perirenal effusion infection, and septic shock for patients with calculous pyonephrosis.Despite the fact that there were more patients who developed fever after stage ⅠPCNL, hospitalization costs were lower, indwelling nephrostomy tube time, overall hospitalization time, and postoperative hospitalization time were all reduced. 【Conclusion】 ⅠPCNL was affordable, safe, and successful for treating renal and upper ureteral calculi with pyonephrosis, and it had some promotional value in clinical practice.

Objective To investigate the biological basis of disease and syndrome by studying the spectrum of myocardial tissue metabolites in the rat model of coronary heart disease with heart blood stasis syndrome.Methods SD rats were randomly divided into sham-operation group and model group.The left anterior descending coronary artery was ligated to prepare the rat model of coronary heart disease with heart blood stasis syndrome.The general condition was observed,and the tongue chromaticity,electrocardiogram,cardiac function were detected.HE staining and transmission electron microscopy were used to observe myocardial tissue morphology and ultrastructure.UPLC-MS technology was used to investigate the differential metabolites in rat myocardial tissue,and enrichment analysis was conducted on metabolic pathways.Results Compared with the sham-operation group,the tongue chromaticity R,G,B values of model group rats were significantly reduced(P<0.05),ECG heart rate and ST segment elevation amplitude significantly increased(P<0.05),LVEF and LVFS significantly decreased,and LVIDs and LVIDd significantly increased(P<0.05).Myocardial tissue pathology revealed that the structure was blurred,inflammatory cells infiltrated,mitochondria swelled,ruptured,and dissolved,and crista structure fracture decreased.A total of 29 potential biomarkers with significant differences between the sham-operation group and the model group were identified in metabolomics(7 upregulated and 22 downregulated),with the majority of 10 pathways enriched in thiamine metabolism,arginine biosynthesis,purine metabolism,aminoacyl-tRNA biosynthesis,alanine,aspartate and glutamate metabolism,pentose and glucuronate interconversions,glycolysis/gluconeogenesis,valine,leucine and isoleucine degradation,TCA cycle,pyruvate metabolism.Conclusion Ligation of the left anterior descending coronary artery can mimic the pathological process of coronary heart disease with blood stasis syndrome in a good way,and its pathological mechanism involves the disruption of multi-level metabolic networks such as glucose metabolism,mitochondrial energy metabolism,amino acid metabolism,protein biosynthesis,and purine metabolism.

By reviewing ancient materia medica， medical books and modern literature， this paper conducted a systematic research on name， origin， scientific name evolution， producing area， quality， harvesting and processing methods of Alpiniae Officinarum Rhizoma. The results showed that Alpiniae Officinarum Rhizoma was first published in Mingyi Bielu， and its correct name was Gaoliangjiang. The mainstream origin of Alpiniae Officinarum Rhizoma used in the past dynasties is Alpinia officinarum， which is used to this day， while it used to be mixed with A. galanga because of the similar name and morphology. Alpiniae Officinarum Rhizoma produced in Danzhou and Leizhou was considered to be better in ancient times， and now it mainly produced in Guangdong， Guangxi and Hainan provinces. In addition， it has been concluded that Alpiniae Officinarum Rhizoma with reddish brown， sturdy and firm character， wrinkled skin， convex flesh， aromatic and spicy taste， and few branches is the best. In ancient times， Alpiniae Officinarum Rhizoma was commonly harvested in February and March， whereas it generally harvested in late summer or early autumn at present， and wild products are usually harvested before the rainy season in May. The main processing methods of Alpiniae Officinarum Rhizoma are cleansing and cutting， and some other methods are stir-frying or mixing with auxiliary materials. Based on the research results， it is suggested that the raw products of A. officinarum rhizomes or its processed products according to prescription requirements should be used in the development of famous classical formulas containing Alpiniae Officinarum Rhizoma.

Due to its high incidence and mortality rate， acute myocardial infarction poses a serious threat to public health. Reperfusion therapy is the preferred treatment strategy for acute myocardial infarction， which can quickly restore blood circulation to the ischemic myocardium， rescue dying myocardial cells， reduce infarct size， and lower the mortality rate. However， reperfusion may lead to additional heart damage， known as myocardial ischemia-reperfusion injury （MIRI）. Therefore， how to alleviate MIRI has become one of the urgent issues in cardiovascular therapy. Traditional Chinese medicine （TCM） has the advantage of multiple components， multiple pathways， and multiple targets in the treatment of MIRI， providing new ideas for reducing MIRI. Adenosine 5'-monophosphate （AMP）-activated protein kinase （AMPK） is closely related to MIRI， and it plays an important role in alleviating MIRI by regulating inflammation， oxidative stress， autophagy， apoptosis， and ferroptosis. This article reviewed the basic structure of the AMPK signaling pathway and its role in MIRI， as well as the research progress of TCM in the treatment of MIRI by regulating the AMPK pathway， aiming to provide a theoretical basis for the prevention and treatment of MIRI.

Chronic heart failure （CHF）， the end stage of heart disease due to a variety of causes， features high disability rate and mortality， which has become a hot spot in cardiovascular field. As recorded in Treatise on Cold Damage（《伤寒论》）， Zhenwutang is composed of Radix Aconiti Lateralis Preparata， Poria Cocos， Rhizoma Atractylodis Macrocephalae， Paeoniae Radix Alba， and Rhizoma Zingiberis Recens. With the functions of warming Yang and excreting water， it is a classical prescription for the treatment of CHF in clinical settings. By searching China National Knowledge Infrastructure （CNKI）， PubMed， Wanfang Data， and VIP， we find Zhenwutang exerts therapeutic effect on CHF through multiple targets and multiple pathways. Experiments show that it alleviates CHF by antagonizing the overactivation of neuroendocrine system， inhibiting immune-inflammatory response， suppressing cardiac remodeling， restricting apoptosis， regulating autophagy， improving myocardial energy metabolism， inhibiting oxidative stress injury， protecting endothelial function， and decreasing volume load. Clinical research shows that Zhenwutang can significantly alleviate the clinical symptoms of CHF patients in a safe manner with little adverse reactions. This paper systematically summarizes the mechanisms of and clinical research on Zhenwutang in the treatment of CHF in recent years， so as to provide theoretical and experimental data for the further research and development of Zhenwutang.

Objective:To explore the significance of the clinical target volume (CTV) dose optimization in the upper and middle neck in protecting the laryngopharynx, anterior and posterior rings during intensity-modulated radiotherapy (IMRT) and multimodal imaging system for nasopharyngeal carcinoma.Methods:Clinical data of 298 nasopharyngeal carcinoma patients admitted to Jiangsu Cancer Hospital from 2016 to 2018 were retrospectively analyzed. According to the following five strategies of CTV dose optimization in the upper and middle neck: group A, complete optimization of bilateral cervical lymph nodes (CLNs), that is, the CTV doses of bilateral CLNs were 50.4 Gy; group B, complete optimization of unilateral CLNs, that is, the CTV dose of unilateral CLNs was 50.4 Gy and the contralateral CLNs was 60 Gy; group C, incomplete optimization of bilateral CLNs, that is, the CTV doses of bilateral CLNs were 50.4 Gy, while the suspicious positive CLNs were selectively boosted to 60 Gy; group D, incomplete optimization of unilateral CLNs, that is, the CTV dose of unilateral CLNs was 50.4 Gy and the suspicious positive CLNs were selectively boosted to 60 Gy, and the CTV dose of contralateral side was 60 Gy; group E: no optimization, that is, the CTV doses of bilateral CLNs were 60 Gy.Results:Among 298 patients, 215 patients received dose optimization and 83 cases did not receive dose optimization. In the dose optimization schemes, 114 cases were assigned in group A, 36 cases in group B, 60 cases in group C and 5 cases in group D. The median (range) follow-up time was 28.5(6.0-46.3) months. The overall survival rate was 95.6%, the progression-free survival rate was 84.2% and the locoregional control rate of CLNs was 98.0%. Local relapse of CLNs occurred in six patients, including 1 case of retropharyngeal lymph node, 4 cases of Ⅱ area and 1 case of Ⅳ area. The P values of average dose of laryngopharynx in group A, group B, group C and group D compared with that in group E were<0.001, 0.016, 0.001 and 0.572, respectively. The P values of the average dose of the anterior ring in group A, group B, group C and group D compared with that in group E were<0.001, 0.011, <0.001 and 0.805, respectively. The P values of the average dose of the posterior ring in group A, group B, group C and group D compared with that in group E were<0.001, 0.004, <0.001 and 0.252, respectively.Conclusions:Combined with the metastatic rules of CLNs and multimodal imaging system, it is safe to optimize the CTV dose of the upper and middle neck during IMRT in nasopharyngeal carcinoma patients, which can significantly reduce the doses of laryngopharynx, anterior and posterior rings, thereby providing evidence for reducing the CTV dose in the upper and middle neck.

Using four Uncariae Cum Uncis materials including Uncaria sinensis (HGT), U. hirsutea (MGT), Jianhe U. rhynchophylla (JHGT) and U. rhynchophylla(GT) as the research objects, the correlations between medicinal materials' yield and photosynthetic ecophysiology-factors in the plant exuberant growth period were studied. Results showed that the Uncaria plants net photosynthetic rate (Pn) changed by unimodal curve. There was not "midday depression" phenomenon. There was a different relationship among the photosynthetic ecophysiology-factors and between photosynthetic ecophysiology-factors and medicinal materials' yield. Pn,Tl,Gs had a significant correlation with medicinal materials' yield（M）and were the most important factors of growth.

The CRISPR/Cas (clustered regularly interspaced short palindromic repeats/CRISPR-associated proteins) system was first identified in bacteria and archaea and can degrade exogenous substrates. It was developed as a gene editing technology in 2013. Over the subsequent years, it has received extensive attention owing to its easy manipulation, high efficiency, and wide application in gene mutation and transcriptional regulation in mammals and plants. The process of CRISPR/Cas is optimized constantly and its application has also expanded dramatically. Therefore, CRISPR/Cas is considered a revolutionary technology in plant biology. Here, we introduce the mechanism of the type II CRISPR/Cas called CRISPR/Cas9, update its recent advances in various applications in plants, and discuss its future prospects to provide an argument for its use in the study of medicinal plants.

Objeetive To discuss risk factors for postoperative complications after Mini-percutaneous nephrolithotomy (mPNL) using modified Clavien classification of surgical complications.Methods From September 1999 to December 2010,4533 patients having complications after mPNL were analyzed with five related clinical factors using the modified Clavien classification of surgical complications in the Second Affiliated Hospital of Kunming Medical University.Results Among 88 cases having complications (1.94％),69 had hemorrhage (0.24％),5 had colon injury (0.11％),3 had septic shock (0.06％),5 had liquid absorption syndrome (0.11％),6 had pleural effusion (0.13％).According to the modified Clavien classification,11 cases were clustered into Class Ⅰ (0.24％),71 cases into Class Ⅱ (1.56％),6 cases into Class Ⅲa (0.13％) and no cases was classified in Class Ⅲ b,Ⅳ a,Ⅳ b and Ⅴ.For patients having complications of Class Ⅱ and Ⅲ,the average hospital stay was significantly longer than those having either Class Ⅰ or no complications.Multiple logistic regression analysis showed that five factors were associated with postoperative complications,including operation time (OR=1.46),ASA score (0 =2.49),having cardiovascular disease or diabetes at the same time (0R=1.67),stone load (0R=1.34) and positive urine culture (0R=0.97).Conclusion Using modified Clavien classification of surgical complications in the analysis of mPNL was standard,objective,applicable and recommended.