Sinisan is a classical prescription developed and applied by ancient medical experts and it is first recorded in the Treatise on Cold Damage written by ZHANG Zhongjing in the Eastern Han Dynasty. Later physicians have modified this prescription based on this original one. The bibliometrics methods were used to analyze the key information and research trend of Sinisan. According to the inclusion and exclusion criteria， 69 pieces of effective data were extracted， involving 67 ancient traditional Chinese medicine （TCM） books. The results showed that the name， composition， and decocting methods of Sinisan in later generations were inherited from the original record in the Treatise on Cold Damage. The original plants of medicinal materials used in Sinisan are basically clear. We recommend Bupleuri Radix as the dried root of Bupleurem scorzonerifolium， Paeoniae Radix Alba as the dried root of Paeonia lactiflora， Aurantii Fructus as the dried fruit of Citrus aurantium， Glycyrrhizae Radix et Rhizoma as the dry root and rhizome of Glycyrrhiza uralensis. Raw materials of Bupleuri Radix and Paeoniae Radix Alba， Aurantii Fructus stir-fried with bran， and stir-fried Glycyrrhizae Radix et Rhizoma should be used for preparation of Sinisan. According to measurement system in the Han Dynasty， a bag of Sinisan is composed of 1.25 g Bupleuri Radix， 1.25 g Paeoniae Radix Alba， 1.25 g Aurantii Fructus， and 1.25 g Glycyrrhizae Radix et Rhizoma. The materials should be grounded into coarse powder and taken with a proper amount of rice soup， 3 times a day. Sinisan has the effects of regulating qi movement and harmonizing the liver and spleen. It can be used for treating reversal cold in limbs and cold damage. In modern clinical practice， Sinisan can be used to treat chronic gastritis， irritable bowel syndrome， and dyspepsia. The above research results provide scientific reference for the future research and development of Sinisan.

This paper elucidates the connotation and extension of the concept of "impending illness" from the perspective of logic. The connotation of impending illness refers to the intermediate state between health （not yet sick） and disease （already sick）， characterized by the initial instability of yin and yang or a low-level balance of yin and yang as its internal mechanism， and mild dysfunctions in physiological， psychological， and social functions as its manifestations. The extension of impending illness includes latent disease status and pre-disease status. By adopting a creative hermeneutic approach to explore the deep-seated connotations of impending illness， this paper systematically analyzes the concept of impending illness from five levels： the existential level， the intentional level， the implicational level， the situational level， and the necessitational level， arguing that impending illness represents the unity of ambiguity and precision， the deviation of the human body system from homeostasis within a certain range， and an important component of the improvement of the traditional Chinese medicine health management system. Thoroughly explicating and clarifying the concept of "impending illness" can provide theoretical references for the study of transitional states between health and disease and the improvement of the traditional Chinese medicine health management system.

Objective To explore the value of magnetic resonance relaxation time quantitative imaging in predicting molecular subtypes of invasive ductal carcinoma(IDC)of breast.Methods A total of 79 IDC patients underwent routine magnetic resonance imaging(MRI)scanning and relaxation time quantitative imaging.According to immunohistochemical results of lesions,patients were divided into different immunohistochemical index groups and molecular subtype groups.The differences in MRI signs,T1 values and T2 values of lesions were statistically compared between each group.Patient operating characteristic(ROC)curve was used to evaluate values of T1 and T2 alone and the combination of them in differential diagnosis of IDC molecular subtypes.Results There were 82 samples of lesion in 79 patients,in which,Luminal A type 16(19.51%),Luminal B1 type 11(13.41%),Luminal B2 type 27(32.93%),tyrosine kinase receptor-2 overexpression type(Erb-B2)14(17.07%)and TNBC 14(17.07%).There were no significant differences in patient age,lesion distribution,maximum diameter,morphology,margin and enhancement performance between patients with various molecular subtypes(P>0.05).Among the immunohistochemical indexes,only the Ki-67 positive group had higher T1 value than the negative group(P<0.05).In ROC analysis,the critical T1 value of Ki-67 positive lesions was 2 145 ms,Yoden index was 0.368,the sensitivity was 53.47%,the specificity was 83.33%and the area under the curve(AUC)was 0.640(95%CI:0.527-0.744).There were no significant differences in T1 and T2 values between Luminal A,Luminal B1,Luminal B2,Erb-B2 enriched and TNBC subtypes(P<0.05).T1 and T2 values were lower in Luminal type lesion than those of TNBC type lesion(P＜0.05).ROC curve analysis showed that the combined T1 and T2 values were more effective in differentiating Luminal/TNBC type than those of T1 and T2 values alone.Conclusion T1 mapping can be used as one of the methods to predict the high or low expression levels of Ki-67 in IDC tumors.The combination of T1 and T2 values can improve the ability to predict Luminal/TNBC subtypes.

Objective:Radiotherapy is the primary treatment for nasopharyngeal carcinoma,but it frequently leads to radiotherapy-induced temporal lobe injury(RTLI).Magnetic resonance imaging(MRI)is the main diagnostic method for RTLI after radiotherapy for nasopharyngeal carcinoma,but it is prone to missed diagnoses.This study aims to investigate the causes of missed diagnoses of RTLI in nasopharyngeal carcinoma patients undergoing MRI after radiotherapy. Methods:Clinical and MRI data from nasopharyngeal carcinoma patients diagnosed and treated with radiotherapy at Xiangya Hospital of Central South University,from January 2010 to April 2021,were collected.Two radiologists reviewed all head and neck MRIs(including nasopharyngeal and brain MRIs)before and after radiotherapy of identify cases of late delayed response-type RTLI for the first time.If the original diagnosis of the initial RTLI in nasopharyngeal carcinoma patients did not report temporal lobe lesions,it was defined as a missed diagnosis.The first diagnosis of RTLI cases was divided into a missed diagnosis group and a non-missed diagnosis group.Clinical and imaging data were compared between the 2 groups,and multivariate logistic regression analysis was used to identify independent risk factors for MRI missed diagnoses of initial RTLI. Results:A total of 187 nasopharyngeal carcinoma with post-radiotherapy RTLI were included.The original diagnostic reports missed 120 cases and accurately diagnosed 67 cases,with an initial RTLI diagnosis accuracy rate of 35.8%and a missed diagnosis rate of 64.2%.There were statistically significant differences between the missed diagnosis group and the non-missed diagnosis group in terms of lesion size,location,presence of contralateral temporal lobe lesions,white matter high signal,cystic degeneration,hemorrhage,fluid attenuated inversion recovery(FLAIR),and examination site(all P<0.05).Multivariate logistic regression analysis showed that lesions≤25 mm,non-enhancing lesions,lesions without cystic degeneration or hemorrhage,lesions located only in the medial temporal lobe,and MRI examination only of the nasopharynx were independent risk factors for missed MRI diagnosis of initial RTLI(all P<0.05). Conclusion:The missed diagnosis of initial RTLI on MRI is mainly related to lesion size and location,imaging characteristics,and MRI examination site.

Background A variety of substances in drinking water are hazardous to human health and there are health risks associated with ingestion of these substances via drinking water. Objective To assess the carcinogenic and non-carcinogenic health risks of drinking water in Shijiazhuang from 2014 to 2021. Methods The collection, preservation, and testing of 10529 drinking water samples (including finished water and tap water) in Shijiazhuang were conducted from 2014 to 2021 and followed the Standard examination methods for drinking water (GB/T 5750—2006). The health risks of 15 chemicals in drinking water by oral exposure were assessed using the US Environmental Protection Agency's four-step method combined with Monte Carlo simulation. Results Among the 15 chemicals in drinking water assessed for their health risks at general exposure levels and high exposure levels via oral route in Shijiazhuang from 2014 to 2021, the leading three chemicals and related values of carcinogenic risks for adults were cadmium (1.11×10⁻⁴, 2.98×10⁻⁴), arsenic (5.88×10⁻⁵, 1.56×10⁻⁴), and chromium (5.48×10⁻⁵, 2.41×10⁻⁴), and the leading three chemicals and related values of non-carcinogenic risks were fluoride (3.57×10⁻¹, 6.57×10⁻¹), arsenic (1.31×10⁻¹, 3.47×10⁻¹), and nitrate (1.14×10⁻¹, 5.98×10⁻¹). The health risk values of trichloromethane and aluminum were elevated but still in acceptable ranges. Drinking water-associated health risk values were higher in males than in females, such as the cancer risk for general exposure levels of arsenic in men was 5.76×10⁻⁵, compared to 5.72×10⁻⁵ in women. The health risk values of cadmium, chromium, fluoride, nitrate, and other chemicals in ground water were higher than those of surface water, and the health risk values of trichloromethane and carbon tetrachloride were lower than those in surface water, such as the non-carcinogenic risk value for general exposure levels of fluoride in groundwater was 3.61×10⁻¹, compared to 2.27×10⁻¹ in surface water. Factors such as water transmission and distribution links, water period, and season affected the health risks of drinking water. The general exposure levels of trichloromethane in tap water had a higher carcinogenic risk of 1.75×10⁻⁷ compared with 8.17×10⁻⁸ in finished water. The general levels of arsenic exposure was higher in the dry season at 1.36×10⁻¹, compared with 1.26×10⁻¹ in the wet season. Conclusion Except that the carcinogenic risk of cadmium at general exposure levels in Shijiazhuang exceeds the maximum acceptable range recommended by US Environmental Protection Agency, the health risk values of the remaining 14 chemicals are below the maximum acceptable risk. The carcinogenic risk values of arsenic and chromium and the non-carcinogenic risk values of fluoride, arsenic, and nitrate are relatively high, but do not exceed the maximum acceptable ranges. The emphasis should be on the management of drinking water in highly exposed areas and populations.

Cinnamomum migao plants often face different degrees of drought in karst habitats, which can lead to plants’ death, especially in the seedling stage. Widespread of arbuscular mycorrhizal (AM) fungi in karst soils have the potential to address this drought, which is a threat to C. migao seedlings. We inoculated C. migao seedlings with spores from Glomus lamellosum and Glomus etunicatum, two AM fungi widely distributed in karst soils, to observe seedling growth response after simulated drought. Our results showed that 40 g of G. lamellosum and G. etunicatum significantly promoted the growth of C. migao seedlings, 120 days after inoculation. Following a 15-day drought treatment, root colonization of the seedlings with G. lamellosum or G. etunicatum had lower the accumulation of malondialdehyde (MDA) and increased the accumulation of enzymes and osmotic substances in the seedlings. The relative water content in different organs (roots, stems, and leaves) of the drought-stressed seedlings was higher in plants with G. lamellosum or G. etunicatum than in plants without AM fungi colonization. Our results showed that inoculation with AM fungi was an effective means to improve the drought resistance of C. migao seedlings.

Cinnamomum migao plants often face different degrees of drought in karst habitats, which can lead to plants’ death, especially in the seedling stage. Widespread of arbuscular mycorrhizal (AM) fungi in karst soils have the potential to address this drought, which is a threat to C. migao seedlings. We inoculated C. migao seedlings with spores from Glomus lamellosum and Glomus etunicatum, two AM fungi widely distributed in karst soils, to observe seedling growth response after simulated drought. Our results showed that 40 g of G. lamellosum and G. etunicatum significantly promoted the growth of C. migao seedlings, 120 days after inoculation. Following a 15-day drought treatment, root colonization of the seedlings with G. lamellosum or G. etunicatum had lower the accumulation of malondialdehyde (MDA) and increased the accumulation of enzymes and osmotic substances in the seedlings. The relative water content in different organs (roots, stems, and leaves) of the drought-stressed seedlings was higher in plants with G. lamellosum or G. etunicatum than in plants without AM fungi colonization. Our results showed that inoculation with AM fungi was an effective means to improve the drought resistance of C. migao seedlings.

Objective:To analyze the implementation of evidence-based nursing indicators for deep open wound pain management and its difficulties.Methods:From May to October 2018 at Department of Traumatology and Orthopaedics, Nanfang Hospital, 2 nurses were selected by objective sampling and 20 patients with deep open wound by convenient sampling. According to the 13 best practices in nursing guidelines for pain management, we formulated a no-pain dressing change program for deep open wounds on the basis of the research evidence in wound care and pain management. After the program was implemented, its effect on pain relief was evaluated. Practical Application of Clinical Evidence System (PACES) and software GRiP were used to evaluate the whole implementation process. IBM SPSS 21.0 was used to analyze the pain scores before and after implementation.Results:The results of PACES showed that the implementation rate of best practices by the 2 nurses increased significantly during the project period and remained at a reasonable level one month after the project. The patients＇ pain scores before dressing were 3.2±2.3 and 3.5±1.2 at the baseline evaluation and the follow-up evaluation 1, respectively; the pain scores during dressing at the base evaluation and the subsequent evaluation 1 were 5.4±2.3 and 4.2±2.4. The effect of implementation of evidence-based nursing indicators for deep open wound pain management on pain relief was significant ( P<0.05). Conclusions:This project improved the implementation rate of the best pain management practices in dressing change for deep open wounds, but the implementation encountered difficulties in interdisciplinary cooperation and organizational structure. This study may provide a reference for other evidence-based nursing projects aiming at transforming evidence-based nursing guidelines into clinical practice.

OBJECTIVE： To systematically evaluate the efficacy and safety of Endostar combined with gemcitabine and cisplatin in the treatment of non-small cell lung cancer （NSCLC）， and to provide evidence-based reference for clinical drug use. METHODS： Retrieved from Cochrane Library， PubMed， Embase， ClinicalTrials， CNKI， Wanfang and VIP database， randomized controlled trials （RCT） about Endostar combined with gemcitabine and cisplatin（trial  group） vs. gemcitabine combined with cisplatin （control group） for NSCLC were collected. After literature screening， data extraction and quality evaluation with Cochrane 5.1.0 bias risk evaluation tool and Jadad scale， Meta-analysis was performed by using Rev Man 5.3 software. RESULTS： A total of 27 RCTs were included， involving 1 646 patients. Results of Meta-analysis showed that response rate [RR＝1.67， 95％CI（1.48，1.89），P＜0.000 01] and clinical benefit rate [RR＝1.26， 95％CI （1.20， 1.33），P＜0.000 01] of trial group were significantly higher than those of control group. There was no statistical significance in the incidence of leucopenia [RR＝0.98，95％CI（0.88， 1.11），P＝0.79]， thrombocytopenia [RR＝1.07， 95％CI（0.91， 1.26），P＝0.39] and gastrointestinal reaction [RR＝1.01， 95％CI（0.90， 1.14），P＝0.85] between 2 groups. CONCLUSIONS： Endostar combined with gemcitabine and cisplatin can improve therapeutic efficacy of NSCLC patients， without increasing the incidence of ADR.

OBJECTIVE： To establish HPLC fingerprint of Pholidota chinensis and cluster analysis the samples， and to provide reference for quality evaluation of P. chinensis. METHODS： HPLC fingerprints of 16 batches of P. chinensis from Guangxi， Guangdong and Fujian were established according to 2012 edition of Similarity Evaluation System for Chromatographic Fingerprint of TCM [chromatographic column was Agilent SB-aq column with mobile phase consisted of acetonitrile-0.05％ phosphoric acid solution （gradient elution）， at the flow rate of 1.0 mL/min. The detection wavelength of 220 nm， the column temperature was 30 ℃ and the sample volume was 5 μL].The cluster analysis was carried out by using SPSS 22.0 statistical software. RESULTS： Accoding to the established HPLC fingerprint， 11 common peaks were indentified， and the common peak 1 was identified as gastrodin； the similarity of 16 batch of samples was greater than 0.9. 16 batches of medicinal materials could be divided into 2 groups. CONCLUSIONS： The established HPLC fingerprint and cluster analysis can provide reference for the quality control of     P. chinensis.