[Objective]To analyze YE Tianshi's method of removing stagnant Qi and the characteristics of the medication used,with a view to provide new ideas for the clinical diagnosis and treatment of splenic pure heat(metabolic syndrome).[Methods]The origin and development of the concept of stagnant Qi and its interpretation by medical practitioners through the ages were systematically analyzed by means of literature review,focusing on the theoretical basis of"Lan removes stagnant Qi"in the Huangdi's Internal Classic and its evolution during the Ming and Qing dynasties.Focusing on YE Tianshi's medical and pharmacological ideas,it summarized his medication pattern in treating splenic pure heat,including the selection of medicines,the principles of compounding and the therapeutic goals,so as to reveal the core of his prevention and treatment concepts.Based on modern Chinese medicine theory,the concept of stagnant Qi was re-examined,its association with modern metabolic diseases was analyzed,and the modern application of the method of removing stagnant Qi was evaluated.[Results]Stagnant Qi is regarded as an abnormal state of accumulation of essence and micro-substances,which is closely related to metabolic imbalance and is a key link in the progression of diseases.The method of removing stagnant Qi is rooted in"Lan removes stagnant Qi"of Huangdi's Internal Classic.YE Tianshi,through precise diagnosis,used the method of removing stagnant Qi as the core and combined it with ginseng and Huangdi's Internal Classic,which effectively intervened in the splenic pure heat and minimized the incidence of thirst,although the specific strategy of the medication needed to be supported by more researches.As one of the key therapeutic principles of Chinese medicine in the treatment of metabolic diseases,although the method of removing stagnant Qi shows potential in the modern treatment of metabolic diseases,its specific usage and drug utilization are still in the stage of accumulating experience,and further in-depth excavation and research are needed.[Conclusion]YE Tianshi's method of removing stagnant Qi provides a new theoretical perspective for the understanding of metabolic diseases in Chinese medicine,emphasizing the importance of early intervention.The study not only deepens the stagnant Qi theory but also provides guidance for clinical practice,but more experimental studies and clinical data are needed to refine its application.Future work should focus on the mechanism study and clinical validation of the stagnant Qi removal method with a view to play a greater role in the treatment of metabolic diseases.

Objective:To study the spatiotemporal heterogeneity of the incidence rate of pulmonary tuberculosis and its macro influencing factors in China, so as to provide a reference for the relevant departments to formulate prevention and control policies.Methods:In virtue of the complexity of influencing factors, a new method combining principal component analysis (PCA) with geographically and temporally weighted regression (GTWR) was proposed to analyze the spatiotemporal heterogeneity of influencing factors for pulmonary tuberculosis. Using the data of incidence rate of pulmonary tuberculosis and gross regional product (secondary indicators) of 31 provinces (excluding Hong Kong, Macao, and Taiwan) in China from 2010 to 2019, a macro influencing factor indicator system was established by the PCA scores of 21 secondary indicators quantified to determine four primary indicators: comprehensive economy, medical security, cultural and educational transportation, and resources and environment. Based on the indicator system, PCA-ordinary least squares (PCA-OLS) model, PCA-geographically weighted regression (PCA-GWR) model, and PCA-GTWR model were constructed.Results:Three models passed F-test with F-values of 58.74, 196.62, and 1 202.90 respectively (all P < 0.05), indicating that the impact of the primary indicators on the incidence of tuberculosis is statistically significant. The mean squared error (0.01), the mean absolute error (0.08), the mean absolute percentage error (0.02), and the corrected Akaike information criterion (-358.76) of PCA-GTWR were lower than those of PCA-OLS (0.13, 0.28, 0.07, 258.38) and PCA-GWR (0.06, 0.15, 0.03, 23.41). Meanwhile, the determination coefficient (0.95) of PCA-GTWR was higher than that of PCA-OLS (0.44) and PCA-GWR (0.77), indicating the goodness of fit of the model is the best. And the PCA-GTWR model showed that the comprehensive economy, medical security, cultural and educational transportation, and resources and environment had significant spatiotemporal heterogeneity on the incidence rate of pulmonary tuberculosis according to the distribution of regression coefficients. Conclusion:It is necessary to comprehensively consider various factors and formulate detailed and overall prevention and control measures for pulmonary tuberculosis according to local conditions.

Constraint-based genome-scale metabolic network models (genome-scale metabolic models, GEMs) have been widely used to predict metabolic phenotypes. In addition to stoichiometric constraints, other constraints such as enzyme availability and thermodynamic feasibility may also limit the cellular phenotype solution space. Recently, extended GEM models considering either enzymatic or thermodynamic constraints have been developed to improve model prediction accuracy. This review summarizes the recent progresses on metabolic models with multiple constraints (MCGEMs). We presented the construction methods and various applications of MCGEMs including the simulation of gene knockout, prediction of biologically feasible pathways and identification of bottleneck steps. By integrating multiple constraints in a consistent modeling framework, MCGEMs can predict the metabolic bottlenecks and key controlling and modification targets for pathway optimization more precisely, and thus may provide more reliable design results to guide metabolic engineering of industrially important microorganisms.
Genome ; Metabolic Engineering ; Metabolic Networks and Pathways/genetics* ; Models, Biological ; Thermodynamics

Objective To investigate the clinical efficacy of microsurgical repair of soft tissue necrosis after beak-type calcaneal fracture.Methods From January,2012 to March,2017,surgically flaps were used to repair wounds in 8 patients with soft tissue necrosis after calcaneal beak fracture.Five patients underwent sural neurovascular flap in the first stage of repair,2 patients were treated with peroneal perforator propeller flap,and 1 patient was treated with posterior tibial artery perforator propeller flap.The donor sites of 3 flaps were directly closed,and donor areas of the remaining 5 were covered with medium-thickness skin grafts without being sutured directly.The size of flap was 5.0 cm× 3.0 cm-7.0 cm × 5.0 cm.Through postoperative outpatient and WeChat follow-up.The patient's flap survival,infection,flap shape,sensation and ankle function were evaluated.Results All flaps and skin grafts survived post-operatively.All patients were followed-up for 6-12 (mean,8.4) months.All patients had good flap survival and no complications such as soft tissue and calcaneal infection.The flaps were good in texture,shape and function of ankle.At the last follow-up,according to the British Medical Research Institute (BMRI),the sensory function was divided into 6 levels.The flap sensory function recovered to S2 in 3 cases,and the remaining 5 cases was S1.According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-hindfoot Scale (AHS),the results were excellent in 5 cases,and good in 3 cases.All patients had good clinical results and satisfaction at the last followedup.Conclusion The treatment of soft tissue necrosis after calcaneus beak fractures can be completed in one stage by using flaps,which avoided the occurrence of calcaneal osteomyelitis.It is easy to perform early rehabilitation exercise and the ankle function is well restored.

Objective To investigate the current status of job burnout among anesthetists in Ningxia and to analyze its related risk factors.Methods A total of 310 anesthetists from 30 public hospitals in Ningxia were conducted to collect data on the job burnout by Maslach Burnout InventoryHuman Services Survey (MBI-HSS).The factors associated with severe job burnout and its three domains (high emotional exhaustion,high depersonalization and low personal accomplishment) were included in the multinomial logistic regression analysis.Results The incidence of job burnout and its three domains (high emotional exhaustion,depersonalization and low personal accomplishment) were 18 (5.81％) cases,134 (43.22％) cases,35 (11.29％) cases and 128 (41.29％) cases,respectively.Multinomial logistic regression analysis results indicated that the risk degree associated with job burnout was master and higher degree (OR=4.695,95％CI 1.556-4.172).The risk facts associated with three components of job burnout were work time per week [40-60 h (OR=4.420,CI 2.504-7.802);≥60 h (OR =7.469,95％CI 1.758-31.733)] and tertiary hospital (OR =1.847,95％oCI 1.112-3.069);master and higher degree (OR=2.306,95％CI 1.032-5.155),working years [6-15 years (OR=0.358,95％CI 0.135-0.949)] and cases of anesthesia per year [≥390 cases (OR =3.352,95％CI 1.301-8.639)];secondary hospital (OR =1.717,95％CI 1.045-2.823).Conclusion This survey indicates that job burnout exists among anesthetists in Ningxia and is mainly displayed in emotional exhaustion and low personal accomplishment domains.Master and higher degree tend to occur serve job burnout.

Objective To explore the clinical curative effect for wound surface of hand heatcompression injury treated by improved posrerior interosseous artery reversed island flap.Methods Between January,2010 and September,2015,20 patients were treated for wound surface of hand heatcompression injury.Of 20 cases,there were 16 males and 4 females,aged 18-45 years (mean,32 years);and the left hand was involved in 9 cases and the right hand in 11 cases.Two-stage repair was performed in 20 cases after emergency admission.The locations of heatcompression injury were dorsal hands in 12 cases,first webs in 6 cases,and dorsal thumb in 2 cases.The wound area of hand heatcompression injury were 4.0 cm×5.0 cm-6.0 cm×8.0 cm,which were all repaired by improved interosseous dorsal artery retrograde island flap whose area were 3.5 cm ×4.5 cm-7.0 cm×8.0 cm.One week after operation,fingers and thumb-index web began to promote rehabilitation functional training in the protection of orthosis.All patients were followed-up at regular intervals.Results All postoperative flap and the grafted skin at donor sites survived.Twenty patients were followed-up for 3-12 months (mean,6.5 months).The flaps had satisfactory appearance and soft texture.The thumb web widing and flexion and extension of the fingers were fine.According to Trial Standard Evaluation of the Upper-Limb Part Function of the Hand Surgery Association of the Chinese Medical Association,the results were excellent in 12 cases,good in 6 cases,and fair in 2 cases at 3 months after operation.Conclusion To repair wound surface of hand heatcompression injury by improved posterior interosseous artery reversed island flap is a fairly ideal operative approach.The type of operations is simple in operation,has high survival rate of postoperative skin flap.

Objective To investigate the effects of changing the arteriovenous pressure difference on the survival area of reverse island flap in New Zealand white rabbits models.Methods The saphenous artery and saphenous vein of New Zealand rabbits were selected to design experimental models of reverse island flap.Experi mental rabbits were randomly divided into 4 groups:group A:control group (reserved pedicle integrity of superficial veins);group B:part anastomosis of saphenous artery group (the distal saphenous artery of the flap was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group C:part anastomosis of vein group (distal superficial veins was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group D:ligated superficial veins group (pedicle superficial veins was ligated).After surgery,the flaps were measured by general observation.Blood distribution at different times of the flaps was detected by radionuclide scans.Survival area of the flap was measured to compare the survival rate of flap.Distribution of blood vessels and the state of blood cells were observed by Histological examination.Results The flap survival rate was (82.27-± 11.71)％ in group B,showing significant differences when compared with that group A (47.70-± 11.18)％,group C (47.70 ± 11.18)％ and group D (47.70 ± 11.18)％ (P ＜ 0.05).Radionuclide scans showed that the radioactive material in group B could be seen clearly,the radioactive material in groups A,C and D were a transient existence.Ten days postoperatively,histological observation showed that group B had more capillary regeneration and blood cells remain compared with other groups.Conclusion Increase the blood supply can increase the survival area of the reverse island flap,and simply promote the venous drainage can not effectively improve the survival rate of the flap.

Objective To provide anatomical basis for elevating iliac tissue flap pedicled on the iliolumbar artery.Methods The course,number,outer diameter and distribution of iliolumbar artery were observed on 13 human cadavers.Results All the iliolumbar artery originated from the internal iliac artery.The iliolumbar artery gave off 2 branches (iliacus branch and lumbar branch) when passing between the obturator nerve and the lumbosacral trunk,posteriorly to the psoas major.The mean distance between origin of the iliolumbar artery and bifurcation point to iliacus and lumbar branches was 7.1 (7.1 ± 0.5) cm.The iliacus branch divided into two branches:one artery curved forward and anastomosed with the iliacus branch of deep circumflex iliac artery; the other artery supplied the tissue around the posterior superior iliac spine.The lumbar branch supplied the psoas major and the quadratus lumborum.Conclusion The iliolumbar artery and the iliacus branch is one of the most constant and reliable vessels supplying the iliac bone,and can be used as the pedicle of free or pedicled iliac tissue flaps.

Objective To explore the effects of low-dose X-ray irradiation effects on ischemic flap survival and its possible mechanism.Methods From June, 2014 to December, 2014, 80 SD rats were include in the study, the rats were randomly divided into 2 groups: the experimental group A and control group B.There were 40 rats in each group.The ischemic flaps with the size of 9 cm × 3 cm were designed on the back of the rats.The pedicle of the flaps was near to the tail.A sterile biological isolating membrane was placed under the flap to block the blood supply between muscular layer and flaps.The flaps were intermittently sutured into their original position.The group A was immediately received single and local irradiation of 0.2 Gy after surgery, The group B was not treated.On days 1 to 14 after operation,general observation,HE staining and the western blot of the flaps were performed to calculate the survival vate of the flaps, observe neovascularization and determin the content of VEGF and MMP-9, respectively.Results On the third, seventh and fourteenth days, survival rates of the flaps in the experimental group [(66.46 ± 4.37)％, (44.30 ± 3.86)％, (32.20 ± 4.22)％, respectively] were higher than the control group [(43.15 ± 5.03)％, (27.71 ± 3.20)％, (16.40 ± 5.34)％, respectively] after inspection, there were statistically significant differences between these indices (P ＜ 0.01), HE staining of the flaps in the experimental group were seen in the fibroblast infiltration and neovascularization were higher than that of control group, and experimental group within the lumen of blood vessels were arranged in order, the groups were visible tissue edema obviously control, neovascularization in small numbers, the lumen was irregular.On the third and seventh days, MVD rates of the flaps in the experimental group (85.54 ± 6.12, 44.32 ± 3.56, respectively) were higher than the control group (49.35 ± 4.75,18.75 ± 2.89,respectively) after inspection, there were statistically significant differences between these indices (P ＜ 0.01).VEGF and MMP-9 protein content in the flap for the seventh day in the experimental group were significantly higher than that of the control group.Conclusion Low-dose X-ray irradiation can promote the survival rate of ischemic flap, the mechanism may be related to the expression of VEGF and MMP-9 increased and promoted angiogenesis of the flaps after low-dose X-ray irradiation.

The changes of serum malondialdehyde, myeloperoxidase, total antioxidant capacity, superoxide dismutase activity, and glutathione peroxidase were observed in patients with Graves′ disease. The myeloperoxidase level increased in patients with Graves′ disease. The balance between oxidation and antioxidative defense was disrupted in patients with newly-onset Graves′ disease. Oxidative stress seems to be related to hyperthyroidism.