ObjectiveTo systematically evaluate the efficacy and safety of Qi-reinforcing and blood-activating/stasis-expelling Chinese patent medicines in the treatment of coronary microvascular disease （CMD）. MethodsPubMed， Cochrane Library， CNKI， Wanfang Data， and VIP were searched for the randomized controlled trials （RCTs） on the treatment of CMD with Chinese patent medicines for reinforcing Qi and activating blood/expelling stasis with the time interval from inception to December 31， 2023. The primary outcome indicators included the index of microcirculatory resistance （IMR）， coronary flow reserve （CFR）， and corrected TIMI flow frame count （cTFC）. The secondary outcome indicators included symptomatic efficacy， left ventricular ejection fraction （LVEF）， hypersensitive C-reactive protein （hs-CRP）， nitric oxide （NO）， and adverse events. Cochrane risk-of-bias assessment tool 2.0 （RoB 2.0） and Stata 17.0 were used for literature quality evaluation and meta-analysis of the included RCTs. The Grading of Recommendations， Assessment， Development and Evaluation （GRADE） was used to evaluate the quality of evidence. ResultsA total of 36 RCTs were included in this study， involving 3 029 patients. Compared with conventional Western medicine alone， the combined use of Chinese patent medicines for reinforcing Qi and activating blood/expelling stasis and Western medicine reduced the IMR ［mean difference （MD）=-5.93， 95% confidence interval （95%CI） ［-8.73，-3.14］， n=382， P<0.01］， cTFC （MD=-9.35， 95%CI ［-13.94，-4.76］， n=618， P<0.01）， and hs-CRP ［standard mean difference （SMD）=-1.50， 95%CI ［-1.90，-1.11］， n=1 483， P<0.01］， improved the CFR （SMD=1.14， 95%CI ［0.08，2.19］， n=304， P=0.03）， symptomatic efficacy ［relative risk （RR）=1.36， 95%CI ［1.21，1.53］， n=756， P<0.01］， LVEF （MD=4.39， 95%CI ［2.31，6.47］， n=533， P<0.01）， and NO （SMD=3.16， 95%CI ［2.07，4.25］， n=946， P<0.01） of CMD patients. In terms of safety， the combined therapy reduced the occurrence of adverse events in CMD patients （RR=0.49， 95%CI ［0.29，0.82］， n=591， P=0.01）. GRADE showed moderate quality evidence for adverse events， low quality evidence for cTFC， symptomatic efficacy， LVEF， and NO， and very low quality evidence for IMR， CFR， and hs-CRP. ConclusionBased on microcirculatory function indicators， the combined use of Qi-reinforcing and blood-activating/stasis-expelling Chinese patent medicines and Western medicine may further improve the coronary microvascular function in CMD patients with good safety. The above conclusions remain to be verified with high-quality clinical trials.

Objective:To evaluate the clinical efficacy of heat-sensitive moxibustion combined with kneading and massage manipulation at pain points in treating patients with lumbar disc herniation (LDH) and chronic low back pain (LBP).Methods:Randomized controlled trial. A total of 91 patients with LDH and LBP who were admitted to Lu'an Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were selected as the observation subjects. They were divided into the experimental group (46 cases) and the control group (45 cases) by random number table method. The control group was treated with conventional massage manipulation, while the experimental group was treated with heat-sensitive moxibustion combined with kneading and massage manipulation at pain points. Both groups received 4 weeks of continuous treatment. The degree of lumbar pain was evaluated with the Visual Analogue Scale (VAS), and the degree of lumbar dysfunction was evaluated with modified Oswestry Disability Index (ODI). Plasma viscosity, hematocrit, whole blood low shear viscosity and whole blood high shear viscosity were measured using a blood rheometer. Clinical efficacy was evaluated.Results:The total clinical effective rates in the experimental group and the control group were 93.48% (43/46) and 77.78% (35/45), with a statistical significance between groups ( χ2=4.58, P=0.032). After treatment, the VAS score [(3.81±0.74) vs. (4.29±0.85), t=2.88] and ODI score [(8.79±2.65) vs. (11.25±3.74), t=3.63] of the experimental group were lower than those of the control group ( P<0.01). Plasma viscosity [(1.35±0.06) mPa?s vs. (1.41±0.08) mPa?s, t=4.05], hematocrit [(37.46±2.38)% vs. (40.15±2.94)%, t=4.80], whole blood low shear viscosity [(7.41±1.53) mPa?s vs. (8.64±1.72) mPa?s, t=3.61] and whole blood high shear viscosity [(3.81±0.29) mPa?s vs. (4.07±0.31) mPa?s, t=4.13] were lower than those in the control group ( P<0.01). Conclusion:Heat-sensitive moxibustion combined with kneading and massage manipulation at pain points can effectively relieve LBP in patients with LDH and chronic LBP, improve lumbar dysfunction and hemodynamic status, and enhance clinical efficacy.

Objective Based on gender differences,this paper discusses the characteristics of facial color diagnosis in male and female patients with metaplastic chronic atrophic gastritis(CAG),and explores the pathological mechanism of different gender patients from the perspective of TCM pathogenesis,so as to provide personalized reference for TCM prevention and treatment of metaplastic CAG.Methods In this study,the complexion information of patients with chronic non atrophic gastritis(CNG)and CAG was collected by MT-BX-01 four-diagnostic instrument.The color colorimetric characteristics of male and female metaplastic CAG patients and CNG patients were analyzed by case-control study.Results In female patients,the L value and a value of liver region in CAG with mild intestinal metaplasia(IM)group,moderate and severe IM were significantly lower than those in CNG group(P<0.05).In male patients,the L value of spleen region in CAG with moderate and severe IM group was significantly higher than that in CNG group(P<0.05).Conclusion There is a certain gender difference in the facial color characteristics of patients with metaplastic CAG.The facial chromaticity value of female patients with metaplastic CAG changes most significantly in the liver area,while that of male patients mainly in the spleen area.It is suggested that the incidence of female metaplastic CAG is mostly related to liver,while that of male is mostly related to spleen,which provides a personalized method for clinical diagnosis and treatment of metaplastic CAG based on gender differences.

Objective:To investigate the surgical strategy for giant neurofibromas in the trunk with the goal of precise treatment of superficial tumors.Methods:We retrospectively analyzed the patients with giant neurofibroma of the trunk who admitted to the Department of Plastic Surgery, Southwest Hospital of Army Medical University from January 2021 to March 2023. All patients were treated with "AISS" strategy: (1) autologous blood storage; (2) interventional embolization of the key blood supply artery of the tumor; (3) surgical resection of the tumor; (4) skin graft was harvested from the tumor to repair the secondary defect. Patient demographics, autologous blood storage volume, specific blood vessels and methods of interventional embolization, intraoperative blood loss, intraoperative blood transfusion, complications, and tumor recurrence at follow-ups were documented.Results:A total of 5 patients were enrolled, including 4 males and 1 female, aged 22-32 years. The tumors size ranged from 21 cm×20 cm to 76 cm×66 cm, which were located in the trunk (neck, chest, waist, sacrococcygeal region). The volume of autologous blood storage ranged from 800 to 1 600 ml before the operation. The main blood supply vessels of the tumor were embolized before the operation, including: internal thoracic artery, intercostal artery, external thoracic artery, lumbar artery, inferior epigastric artery, iliolumbar artery and internal iliac artery. All patients underwent radical resection. The intraoperative blood loss was 150-3 000 ml. Patients were transfused with their autologous blood during the operation. There were no severe intraoperative hemorrhage, adverse effects of blood transfusion or infection were not noted. A small skin graft necrosis was noticed in the bilateral iliac fossa in one patient, which was subsequently resolved through dressing change and blade-thickness skin graft transplantation. No tumor recurrence was found during the follow-up period (6-24 months).Conclusion:"AISS" strategy not only safely and accurately treat giant neurofibroma of trunk, but also effectively reduce the intraoperative blood loss and complications, repair of huge wounds in one stage, preventing the recurrence rate of tumors and improving patient satisfaction.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Objective:To investigate the surgical strategy for giant neurofibromas in the trunk with the goal of precise treatment of superficial tumors.Methods:We retrospectively analyzed the patients with giant neurofibroma of the trunk who admitted to the Department of Plastic Surgery, Southwest Hospital of Army Medical University from January 2021 to March 2023. All patients were treated with "AISS" strategy: (1) autologous blood storage; (2) interventional embolization of the key blood supply artery of the tumor; (3) surgical resection of the tumor; (4) skin graft was harvested from the tumor to repair the secondary defect. Patient demographics, autologous blood storage volume, specific blood vessels and methods of interventional embolization, intraoperative blood loss, intraoperative blood transfusion, complications, and tumor recurrence at follow-ups were documented.Results:A total of 5 patients were enrolled, including 4 males and 1 female, aged 22-32 years. The tumors size ranged from 21 cm×20 cm to 76 cm×66 cm, which were located in the trunk (neck, chest, waist, sacrococcygeal region). The volume of autologous blood storage ranged from 800 to 1 600 ml before the operation. The main blood supply vessels of the tumor were embolized before the operation, including: internal thoracic artery, intercostal artery, external thoracic artery, lumbar artery, inferior epigastric artery, iliolumbar artery and internal iliac artery. All patients underwent radical resection. The intraoperative blood loss was 150-3 000 ml. Patients were transfused with their autologous blood during the operation. There were no severe intraoperative hemorrhage, adverse effects of blood transfusion or infection were not noted. A small skin graft necrosis was noticed in the bilateral iliac fossa in one patient, which was subsequently resolved through dressing change and blade-thickness skin graft transplantation. No tumor recurrence was found during the follow-up period (6-24 months).Conclusion:"AISS" strategy not only safely and accurately treat giant neurofibroma of trunk, but also effectively reduce the intraoperative blood loss and complications, repair of huge wounds in one stage, preventing the recurrence rate of tumors and improving patient satisfaction.

As the main product of anaerobic or aerobic glycolysis,lactic acid has long been considered to be only the metabolic waste of this process,but now researches have are gradually revealing that lactic acid,as an important signaling molecule,plays a key immune regulatory role by acting on lactic acid transporters,lactate receptors and intracellular direct sensors in immune cells.In chronic inflammatory diseases,lactic acid helps maintain a pro-inflammatory environment that encourages immune cells to remain at the site of inflammation.In the event of infection,lactic acid impairs host immunity.In the tumor microenvironment(TME),the increase in lactic acid production and the resulting TME acidification promote tumor growth and invasion,and inhibit the body's immune response to tumor antigens.This review focuses on the recent research progress on the role of lactic acid in immune regulation.

Objective To explore the effect of Rhubarb ultrasonic electrical conduction target penetration therapy on the gastrointestinal function of sepsis patients.Methods A total of 88 cases of inpatient sepsis patients diagnosed and treated at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2021 to June 2023 were selected as the participants and the patients were divided into the treatment group and the control group by a simple random method.Both groups were given routine treatments such as anti-infection,fluid resuscitation,nutritional support,blood sugar management,and prevention of stress ulcers,while the treatment group was treated with ultrasonic conductance target penetration Rhubarb therapy at Shenque point and Zhongwan point on the basis of the control group.The main observational indexes were the number of bowel sounds in the two groups before treatment and after 3 days,and 7 days of treatment.The secondary observational indexes were gastric retention,serum C-reactive protein(CRP),procalcitonin(PCT),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),the first defecation time,time to mechanical ventilation,length of stay in the intensive care unit(ICU),hospitalization cost,and 28 days readmission rate of the two groups.The gastric retention was evaluated and recorded every 4 hours before treatment and 3 days and 7 days after treatment,CRP and APACHE Ⅱ score were evaluated before treatment and 7 days after treatment,the 28-day readmission was followed up by telephone.Results A total of 44 cases in the treatment group and 43 cases in the control group completed the intervention.The difference between the bowel sounds and the amount of gastric retention of the two groups was not statistically significant before treatment,with the prolongation of time,the bowel sounds of the two groups gradually increased and the amount of gastric retention gradually decreased,and the number of bowel sounds in the treatment group increased significantly compared to the control group 3 days and 7 days after treatment[beats/minute:4.49(4.23,4.74)vs.3.07(2.80,3.33)3rd day of and 4.79(4.49,5.10)vs.3.36(3.06,3.66)on the 7th day of treatment,both P<0.01],and the amount of gastric retention was significantly reduced compared with the control group[mL:20.93(9.22,32.64)vs.53.52(41.16,65.88)for 3rd day of and 3.72(0.17,7.28)vs.31.59(24.87,38.31)on the 7th day of treatment,both P<0.01].The first defecation time was significantly shorter in the treatment group than in the control group(hours:25.67±9.99 vs.33.64±11.30,P<0.01).After 7 days treatment,the CRP,PCT,and APACHE Ⅱ score were significantly reduced in the treatment group compared to those in the control group[CRP(mg/L):45.97(35.68,56.26)vs.77.30(57.20,97.38),PCT(μg/L):0.94(0.56,1.31)vs.2.73(1.36,4.09),APACHE Ⅱ score:24.11±7.01 vs.28.06±9.25,all P<0.05],the mechanical ventilation time and ICU length of stay were significantly shortened[mechanical ventilation time(hours):107.05±70.76 vs.168.83±136.62,ICU stay time(days):7.58±3.72 vs.9.70±5.15,both P<0.05],the hospitalization cost and 28-day readmission rate were significantly reduced[hospitalization cost(yuan):80337.89±36483.72 vs.109100.24±87080.84,28-day readmission rate:9.1％(4/44)vs.27.9％(12/43),both P<0.05].Conclusion Rhubarb ultrasonic conductive target penetration therapy is a safe,simple,and effective characteristic therapy of external Chinese medicine that can provide a new basis for the protection of gastrointestinal function in patients with sepsis.

Objective:To explore a better measurement mode of shear wave elastography (SWE) in the skin of lymphedema limbs, and to test its diagnostic efficacy in lymphedema.Methods:Between 1st and 10th August, 2023, 22 healthy volunteers were recruited in the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ulrasound, the First Afiliaed Hospital of Sun Yat-Sen University to measure the Young's modulus (E-value) of limb skin by SWE using a gel pad (GP group) and the thick-layer coupling gel (CG group) respectively. Then between 15th August and 28th September, 2023, 11 patients with 13 lower limb lymphedema, who were treated in the Department of Microsurgery, Orhopaedic Trauma and Hand Surgery, the First Affiliaed Hospital of Sun Yat-Sen University, were consecutively enrolled to find out the E-value of skin in oedematous limbs. The receiver operating characteristic curve (ROC) was constructed and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated to evaluate the diagnostic efficiency. SPSS 26.0, R studio and GraphPad Prism 8 software were used for statistical analysis. Paired sample non-parametric test (Wilcoxon signed rank test) was used to compare the difference in E-value between the 2 groups. P<0.01 was considered statistically significant. Spearman correlation test was used to analyse the correlation of E-value values between the GP group and CG group. Results:Overall, it was found from the healthy volunteers that E-value of skin in distal limbs were higher than that in proximal limbs, especially in lower extremities. E-value of all scanned location in GP group were found higher than those of CG group with statistically significant difference ( P<0.01), and the values of interclass correlation coefficient (ICC) showed a good repeatability. The 11 patients with lymphedema in 13 lower extremities were examined with the thick-layer coupling gel. The skin E-value in calf of patients with lymphedema were significantly higher than that of the healthy volunteers ( P<0.01), except the skin of thighs ( P>0.01). A lymphedema was diagnosed while either a skin E-value was 27.6 kPa calculated by Youden index or with the thickness of skin was 2.3 mm. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy in the diagnosis of a lymphedema were found at 92.3%, 100%, 100%, 95.7% and 97.1%, respectively. The area under curve (AUC) of ROC was 0.962. The correlation coefficients (R) of E-value in arm, forearm, thigh and lower leg in the GP group and CP group were 0.665, 0.882, 0.850 and 0.815, respectively, which were all significantly correlated. Conclusion:Application of thick layer coupler in ultrasound skin SWE is highly feasible, and the combination of ultrasound skin SWE and skin thickness has higher diagnostic efficiency in the diagnosis of lower extremities lymphedema. It allows more accurate ultrasonic image technical support for early monitoring and diagnosis of lymphedema, microsurgical treatment and a quantitatively perioperative evaluation.

Objective: Alveolar bone loss is a common adverse effect of intrusion treatment.Mandibular incisors are prone to dehiscence and fenestrations as they suffer from thinner alveolar bone thickness. Methods: Thirty skeletal class II patients treated with mandibular intrusion arch therapy were included in this study. Lateral cephalograms and cone-beam computed tomography images were taken before treatment (T1) and immediately after intrusion arch removal (T2) to evaluate the tooth displacement and the alveolar bone changes. Pearson’s and Spearman’s correlation was used to identify risk factors of alveolar bone loss during the intrusion treatment. Results: Deep overbite was successfully corrected (P < 0.05), accompanied by mandibular incisor proclination (P < 0.05). There were no statistically significant change in the true incisor intrusion (P > 0.05). The labial and lingual vertical alveolar bone levels showed a significant decrease (P < 0.05). The alveolar bone is thinning in the labial crestal area and lingual apical area (P < 0.05); accompanied by thickening in the labial apical area (P < 0.05). Proclined incisors, non-extraction treatment, and increased A point-nasion-B point (ANB) degree were positively correlated with alveolar bone loss. Conclusions While the mandibular intrusion arch effectively corrected the deep overbite, it did cause some unwanted incisor labial tipping/flaring. During the intrusion treatment, the alveolar bone underwent corresponding changes, which was thinning in the labial crestal area and thickening in the labial apical area vice versa. And increased axis change of incisors, non-extraction treatment, and increased ANB were identified as risk factors for alveolar bone loss in patients with mandibular intrusion therapy.