The mild-natured and bitter-flavored traditional Chinese medicines (MB-TCMs) are an important class of TCMs that have been widely used in clinical practice and recognized as safe long-term treatments for chronic diseases. However, as an important class of TCMs, the panorama of pharmacological effects and the mechanisms of MB-TCMs have not been systemically reviewed. Compelling studies have shown that gut microbiota can mediate the therapeutic activity of TCMs and help to elucidate the core principles of TCM medicinal theory. In this systematic review, we found that MB-TCMs commonly participated in the modulation of metabolic syndrome, intestinal inflammation, nervous system disease and cardiovascular system disease in association with promoting the growth of beneficial bacteria Bacteroides, Akkermansia, Lactobacillus, Bifidobacterium, Roseburia as well as inhibiting the proliferation of harmful bacteria Helicobacter, Enterococcus, Desulfovibrio and Escherichia-Shigella. These alterations, correspondingly, enhance the generation of protective metabolites, mainly including short-chain fatty acids (SCFAs), bile acid (BAs), 5-hydroxytryptamine (5-HT), indole and gamma-aminobutyric acid (GABA), and inhibit the generation of harmful metabolites, such as proinflammatory factors trimethylamine oxide (TAMO) and lipopolysaccharide (LPS), to further exert multiplicative effects for the maintenance of human health through several different signaling pathways. Altogether, this present review has attempted to comprehensively summarize the relationship between MB-TCMs and gut microbiota by establishing the TCMs-gut microbiota-metabolite-signaling pathway-diseases axis, which may provide new insight into the study of TCM medicinal theories and their clinical applications.

Objective To investigate the expression and clinical significance of miR-34c and miR-29b in peripheral blood of patients with sensorineural hearing loss.Methods 140 patients with neurological deafness admitted to our hospital from June 2020 to June 2023 were included in the study group,and 40 healthy subjects were included in the control group during the same period.SNHL patients were categorized into 63 cases in the mildly deaf group,42 cases in the moderately deaf group,and 35 cases in the severely deaf group according to their hear-ing impairment.The expressions of miR-34c and miR-29b were detected by qRT-PCR,and VEGF,oxidative stress(TAC,SOD,MDA),NO and Cx26 were detected.Correlation analysis was performed by Pearson test,independent risk factors for SNHL severity were calculated by logistics regression algorithm,and the predictive value of miR-34c and miR-29b on the severity of SNHL patients was evaluated by ROC curve.Results Comparing the levels of NO,TAC,SOD,and Cx26 among the four groups,severe deafness groupmoderate deafness group>mild deafness group>control group(P<0.05).Comparison of miR-34c mRNA and miR-29b mRNA expression levels among the four groups,severe deafness group>moderate deafness group>mild deafness group>control group(P<0.05).Pearson's test showed that SNHL patients'peripheral blood miR-34c and miR-29b were positively correlated with VEGF and MDA,and were negatively correlated with NO,TAC,SOD and Cx26(P<0.05).negative correlation(P<0.05).Multifactorial logistic regression analysis showed that VEGF,MDA,NO,Cx26,TAC,SOD,miR-34c,miR-29b were independent factors affecting the severity of SNHL.Conclusion miR-34c and miR-29b are overexpressed in SNHL patients and can be used as serum markers for predictive assess-ment of disease severity in SNHL patients.

Objective:To investigate the surgical technique and the clinical effects of direct posterior approach (DPA) with the fixation of percutaneous tunnel screw and plate for acetabular posterior comminuted fractures.Methods:Thirty-six cases with acetabular posterior comminuted fractures treated by this technique from January 2016 to July 2020 were retrospectively analyzed in this study. There were 28 males and 8 female, aged 42.0±12.1 (range 19-64) years. According to Letournel-Judet classification, there were 28 cases of transverse associated with posterior wall fractures, 6 cases of posterior column with posterior wall fractures and 2 cases of T shape with posterior wall fractures. DPA was adopted in prone position. The anterior and posterior column fractures of the acetabulum were reduced under direct vision and then fixed with percutaneous tunnel screw. Further, the posterior wall fractures of the acetabulum were reduced and fixed with plate and screws. The operation duration, intraoperative blood loss, incision length, fracture union time, fracture reduction quality, postoperative complications and hip function were recorded.Results:The incision was 9.8±1.2 (range 8-12) cm. The operation duration was 102.9±21.4 (range 65-145) min. Intraoperative bleeding was 214.0±116.9 (range 100-640) ml. Postoperative X-ray and CT examinations showed perfect reduction. All the patients were followed up for 20.9±9.2 (range 10-38) months. The fracture healing time was 4.6±1.0 (range 3-6) months. There was no patient with damaged superior gluteal nerve and blood vessel. There were 2 cases of femoral head cystic changes without pain in walking, 1 case of postoperative infection and bacteremia who was cured at 1 month after debridement and anti-infection treatment, 1 case of sciatic nerve injury but recovered at 3 months after operation, and 1 case of heterotopic ossification at 3 months after surgery without affecting hip motion. According to the Matta's criteria, the reduction quality of the acetabular fracture was rated as excellent in 28 cases, good in 6 cases, fair in 2 cases. According to the modified Merle D'Aubigné and Postel scoring system, hip joint function was excellent in 24 cases, good in 10 cases and fair in 2 cases.Conclusion:DPA approach can directly reduce acetabular posterior comminuted fractures through a minimal incision. Combined with the technique of percutaneous tunnel screw, it displays great advantages of less trauma and with good clinical effects.

Objective: To explore the feasibility of 3D DSA in guidance of uterine artery catheterization (UAE). Methods: A total of 20 patients, including symptomatic uterine leiomyoma (n=8), postpartum hemorrhage (n=5), scar pregnancy (n=3), adenomyosis (n=1) and advanced cervical cancer (n=3) underwent UAE guided by 3D DSA (3D group, n=10) or 2D DSA (2D group, n=10). The relevant clinical indexes of 2 groups were compared. Results: UAE was successfully performed in all 20 patients (40 uterine arteries).No blood supply from ovarian artery was found. The operation time, catheterization time and fluoroscopy time were both shorter, and the dosage of contrast agent and radiation doses were all lower in 3D group than those in 2D group (all P<0.05). Conclusion: 3D DSA can be used to guid UAE, with shorter operation time and lower radiation dose than traditional 2D DSA.

Objective:To investigate the microsurgical anatomy of thoracodorsal artery perforators, and the clinical effect in repairing the soft tissue defect of hand with the thoracodorsal artery perforator flap (TAP).Methods:From October, 2014 to November, 2014, the axillary arteries in 10 thoracodorsal specimens were perfused with red latex. The number and diameter of the perforators of the thoracodorsal arteries were mearsured. From January, 2015 to February, 2019, 52 cases of soft tissue defects in hand combined with bone and extensor tendon exposure were repaired with TAP. The patients were followed-up in outpatient department to observe the clinical efficacy.Results:The number of perforators of thoracodorsal artery was 2-4 mostly, and 3 perforators was the most. The diameter of perforators was 0.22-0.68 mm, and the distance between the perforating point and the posterior axillary wall was 5.2-11.8 cm. All the operations were completed successfully, and the donor sites were closed directly. In 52 cases, 48 flaps survived, 2 had partially necrosis, and 2 had completely necrosis. The patients were followed-up for 5 to 24 months. The blood supply of the flaps was good with soft texture and good appearance.Conclusion:The TAP is an ideal flap because of its thin in thickness, concealed donor area and no obvious scar after direct suture.

Epilepsy mostly starts in childhood and can cause severe mental disorders.Treatment with antiepileptic drugs is effective in most patients, but 20%-30% of the patients continue to have uncontrolled seizures despite medical therapy, these are called drug-resistant epilepsy and need surgical treatment.Critical to discussion of surgical therapy are detailed presurgical evaluation and the lateralization and localization of epileptogenic zone.With deepening of the knowledge of epilepsy and progress of imaging technology, the evaluation of epilepsy surgery is changing gradually.Now, some methods and advances of surgical evaluation for children with drug-resistant epilepsy are reviewed.

Objective: To compare the short-term and long-term outcome between robotic gastrectomy and laparoscopic gastrectomy. Methods: The clinical data of 517 patients who had received robotic gastectomy and laparoscopic gastrectomy between December 2011 and December 2013 at Department of General Surgery, Chinese People′s Liberation Army General Hospital was collected. After propensity score matching, 70 patients in robotic gastectomy and 70 patients in laparoscopic gastectomy were identified. Perioperative outcome and overall survival were compared between the two groups using t test, χ² test, Kaplan-Meier curve and Log-rank test, respectively. Prognosis factors were analyzed by Cox′s proportional hazards regression. Results: There were comparable baseline characteristics between patients in robotic group (RG) and those in laparoscopic group (LG). The conversion rate for RG and LG were 5.7% and 4.3% respectively (P=1.000). Compared with LG, RG had similar lymph node retrieval (25.5±7.2 vs. 24.5±8.3, t=0.770, P=0.443) and less blood loss ((147.0±96.8) ml vs. (188.0±111.2) ml, t=-2.326, P=0.021). There were also similar complications (χ²=0.233, P=0.629) and severity of complications (W=70.500, P=0.053). Although there tended to be early mobility, early flatus and less hospital stay for patients in RG group, the difference between RG and LG was not statistically significant. The 3-year survival rate was 72.9% and 60.0% for patients in RG and patients in LG (P=0.578). Multivariable analysis revealed gender (HR=2.529, 95% CI: 1.042 to 6.140, P=0.040), neoadjuvant chemotherapy (HR=0.272, 95% CI: 0.104 to 0.710, P=0.008) and vascular invasion (HR=2.135, 95% CI: 1.027 to 4.438, P=0.042) were independent prognostic factors. Conclusion Compared with laparoscopic gastrectomy, robotic gastectomy could achieve similar short-term and long-term outcomes.

OBJECTIVETo observe the effect differences among the comprehensive therapy, acupuncture and oral mecobalamine for senile sensorineural hearing loss.

METHODSA total of 126 senile sensorineural hearing loss patients were randomized into a comprehensive group, an acupuncture group and a western medication group, 42 cases in each group. After removing and discontinuing cases, 40 cases in each group were included in the analysis. Acupuncture, acupoint injection and auricular point pressing were used in the comprehensive group. Acupuncture for 2 courses was at the affected Tinggong (SI 19), Tinghui (GB 2), Yifeng (TE 17), etc, once every other day, 10 times as a course with one week rest between 2 courses, 3 times a week. Acupuncture as the comprehensive group was applied in the acupuncture group. Mecobalamin tablet was prescribed orally for 2 courses in the western medication group, 3 times a day, 0.5 mg a time, 3 weeks as a course, one week at the interval. Pure tone hearing threshold value and tinnitus grading were observed before and after intervention in the three groups. The clinical effects were compared.

RESULTSAfter treatment, pure tone hearing threshold value and tinnitus grading were better than those before treatment in the three groups (all <0.05), with better results in the comprehensive group than those in the other two groups (all <0.05). The total effective rate of pure tone hearing threshold value was 82.5% (33/40) in the comprehensive group, which was superior to 67.0% (27/40) in the acupuncture group and 62.5% (25/40) in the western medication group (both <0.05). The total effective rate of tinnitus was 83.3% (30/36) in the comprehensive group, which was superior to 69.7% (23/33) in the acupuncture group and 57.1% (20/35) in the western medication group (both <0.05).

CONCLUSIONThe clinical effects of comprehensive therapy on senile sensorineural hearing loss are superior to those of simple acupuncture and oral administration of mecobalamin in terms of pure tone hearing threshold value and tinnitus grading.

Objectives To investigate the effects of cell aging on the disorders relating to gastric mucosa aging.Methods A treatment of 200 μmol/L H2O2 was used to induce senescence of human gastric epithelial cell line GES-1,and the cell growth curve was monitored.Senescence secretory phenotypes were observed by detecting the protein level of p53 and p16INK4a with senescence-associated β-galactosidase(SA-β gal)staining and Western blot testing.The mRNA levels of senescence-associated secretory phenotype(SASP)factors in human gastric epithelial GES-1 cell including IL-1β,IL-6,IL-8,TGF-β、IFN-γ,and VEGF-A were detected by RT PCR.The mRNA expression levels of IL-1β,IL-6,IL-8,TGF-β,IFN-γ,and VEGF in the conditioned medium were detected by ELISA analysis.Results The 200 μmol/L H2O2-induced GES-1 cells stopped proliferating after 3 days of treatment,and cells enlarged and flattened at 10 days.The increased SA-β-gal staining(P＜0.001) and the increased expression levels of p53 and p16INK4a proteins indicated the success of establishing the aging model of GES-1.The mRNA levels of IL 1β,IL6,IL8,TGF-β,and IFNγ were higher(t=2.94,3.38,3.15,3.64,2.97;P=0.015,0.000,0.000,0.000,0.000)and the mRNA level of VEGF-A was lower(t=2.31,P =0.20) in senescent GES-1 cells than in the control group.In the conditioned medium of senescent GES-1 cells,the levels of IL-1β,IL6,IL8,TGF-β1,and IFNγ were higher in the H2O2-induced group [(3.12±0.21)μg/L,(4.26±0.15)μg/L,(3.37±0.14)μg/L,(5.34±0.19)μg/L,and(2.90±0.47)μg/L]than in the negative control group[(0.24±0.04,0.04±0.07,0.52±0.02,1.05±0.10,0.52±0.02,respectively,P＜0.001)],while the level of VEGF was lower in the H2O2-induced group than in the negative control group(0.21±0.03)μg/L vs (0.59±0.07)μg/L(P＜0.05).Conclusions The changes in senescence-associated secretory phenotype factors of the aging human gastric epithelial cells induced by oxidative stress may promote chronic gastritis and gastric cancer.

Objective To compare the quadratus lumborum block and transversus abdominis plane block for postoperative analgesia in elderly patients undergoing abdominal surgery. Methods Seventy?two elderly patients of both sexes, aged 65-72 yr, with body mass index of 18-25 kg∕m2, of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective laparoscopic cholecystectomy, were di?vided into 2 groups(n=36 each)by coin toss: transversus abdominis plane block group(group T)and quadratus lumborum block group(group Q). Anesthesia was induced and maintained routinely. Bilateral subcostal transversus abdominis plane block was performed under ultrasound guidance in group T. Bilateral paravertebral approach to quadratus lumborum block was performed under ultrasound guidance in group Q. The height of sensory block was assessed at 30 min after block. Ramsay sedation scores and Bruggrmann comfort scale scores were recorded at 30 min after block and 1, 6, 12, 24 and 48 h after operation. The requirement for parecoxib and fentanyl as rescue analgesics and complications such as nausea, vomiting, block of lower extremities and local anesthetic intoxication were recorded within 48 h after operation. Re?sults The height of sensory block was kept at T4?L1, and the main blocking area was T6?11in group T. The height of sensory block was kept at T4?L4, and the main blocking area was T6?L1in group Q. Compared with group T, the blocking area was enlarged, the requirement for parecoxib and fentanyl and incidence of nausea and vomiting were significantly decreased(P<0.05), and no significant change was found in Ram?say sedation scores or Bruggrmann comfort scale scores in group Q(P>0.05). Conclusion Quadratus lumborum block provides better efficacy for postoperative analgesia than transversus abdominis plane block in elderly patients undergoing abdominal surgery.