Objective:To summarize the best evidence for external auditory canal irrigation in patients with cerumen embolism.Methods:The clinical decisions, guidelines, systematic reviews, expert consensus, group standards, evidence summaries, and randomized controlled trials regarding external auditory canal irrigation in patients with cerumen embolism were retrieved from databases and websites such as BMJ Best Practice, UpToDate, Guidelines International Network, National Institute for Health and Clinical Excellence, Joanna Briggs Institute Evidence-Based Health Care Center Database, PubMed, Embase, China National Knowledge Infrastructure, WanFang data, and China Biology Medicine disc. The search period was from database establishment to February 15, 2023. Six researchers screened the literature, evaluated the methodological quality, and extracted and summarized the best evidence for external auditory canal irrigation in patients with cerumen embolism.Results:A total of nine articles were included, including one clinical decision, two guidelines, two systematic reviews, one group standard, and three randomized controlled trials. Sixteen pieces of evidence were summarized from six aspects of operators: pre-operation evaluation and preparation, operation process, post-operation handling, health education, and adverse reactions during operation.Conclusions:This paper summarizes the best evidence for external auditory canal irrigation in patients with cerumen embolism. Medical and nursing staff should carefully select and apply evidence based on clinical scenarios and patient's wishes.

Objective : To explore the general information，clinical features，imaging findings and outcome of pa- tients with drug-induced cholestatic． Methods : The clinical data of patients diagnosed as cholestatic drug-induced liver injury in recent 5 years were analyzed retrospectively，and followed up for at least 6 months. Results : There were 105 patients with drug-induced cholestatic liver injury in the hospital，the median age was 55 years old (54. 3% male) ，most of them had no specific clinical symptoms ; there were nearly 80 kinds of drugs involved，the top three were traditional Chinese medicine (34. 3% ) ，antineoplastic drugs (22. 9% ) and antibiotics ( 10. 5% ) . Among the 49 patients with magnetic resonance cholangiopancreatography ( MRCP) ，7 ( 14. 3% ) had sclerosing cholangitis-like changes ; most of the patients were combined with multiple liver-protecting and enzyme-lowering drugs ; there were 53 cured (50. 5% ) ，41 improved (39. 0% ) ，7 uncured (6. 7% ) ，and 4 died (3. 8% ) among 105 patients，and the total effective rate was 89. 5%． Conclusion Drug-induced cholestatic liver injury mainly oc- curs in elderly patients，involving many kinds of drugs，mainly traditional Chinese medicine．Drugs can also cause changes similar to sclerosing cholangitis，so drug-induced liver injury (DILI) should be used as one of the differen- tial diagnosis of cholestasis and abnormal cholangiography．Liver disease and the number of drugs have no effect on the prognosis of the patients，while low Roussel Uclaf causality assessment method (RUCAM) score and hemoglobin count，short hospitalization time and high white blood cell count are poor prognostic factors.

Objective:To retrospectively analyze the test results of novel coronavirus (2019-nCoV) in different samples (throat swab, sputum and feces) collected from recovered COVID-19 patients in order to provide a more reliable basis for discharge and reduce the risk of recurrence after discharge.Methods:Throat swabs and sputum were sampled in pairs from 78 patients before discharge and sampled in pairs twice from 54 cases with an interval of 1-5 d. Real-time fluorescence quantitative RT-PCR was used to detect the virus in the two types of samples. Throat swab, sputum and fecal samples of six patients were tested for 2019-nCoV during follow-up.Results:The detection rate of viral nucleic acid was 46.15% in throat swabs and 50.00% in sputum samples. Test results of the second paired samples showed that the detection rate of viral nucleic acid was 25.93% in throat swabs and 46.30% in sputum samples, and the difference between the two types of samples was statistically significant ( P<0.05). During follow-up, 2019-nCoV nucleic acid could be detected in the fecal samples of the six patients, but not in their throat swab and sputum samples. Their fecal samples remained positive up to 52 d. Conclusions:In the late convalescence, the respiratory symptoms of COVID-19 patients gradually disappeared with the improvement of clinical symptoms. Moreover, the virus might enter the gastrointestinal tract from respiratory tract, and could long-term exist in recovered patients and be excreted in feces. In order to reduce the rate of missed detection and avoid false negative results, it was suggested to test the viral nucleic acid in different types of samples before a COVID-19 patient was discharged.

Objective To analyze the clinical characteristics, treatments and prognosis of acute obstructive suppurative pancreatic ductitis ( AOSPD) , and to discuss its pathogenesis, diagnosis and treatment strategy. Methods 63 AOSPD cases reported in Chinese and foreign literature from June 1993 to January 2019 were collected. The sex, age of onset, etiology and potential risk factors, clinical manifestations, laboratory examinations, imaging findings, treatments and prognosis were recorded. Results The male to female ratio was 53 / 10, and the median age of onset was 59 years. The etiology and risk factors included chronic pancreatitis, pancreatic neoplasms, diabetes mellitus, history of endoscopic intervention and alcoholism before the onset of AOSPD. The main clinical manifestations were epigastric pain and fever, and sepsis and shock might occur in a few cases. The serum amylase was 13-1946 ( IU/L) at the early stage of onset and it decreased to varying degrees after treatments. Imaging examination showed that pancreatic duct dilatation was found in 54 patients and pancreatic duct stones were found in 42 patients. Pancreatic juice culture was bacteria-positive in more than 31 cases, and the common pathogenic bacteria were Enterococcus and Escherichia coli. Therapeutic methods included endoscopic pancreatic stent implantation ( n=36 ) , endoscopic nasopancreatic drainage (n=22), surgical operation (n=4) and antibiotic treatment, and the condictions in most of the patients were improved to some extent after treatments. Conclusions Older age, male, chronic pancreatic disease, history of endoscopic intervention and drinking, and diabetes mellitus were the main etiological factors of AOSPD. The clinical manifestations of AOSPD were nonspecific but could be complicated by severe complications. Imaging examination and pancreatic juice culture can help to confirm the diagnosis. Antibiotic therapy, timely endoscopic interventions and surgical procedures can improve the short-term prognosis.

Objective: To investigate the effects of resolvin D1 on autophagy in the prevention of acute pancreatitis (AP) in mice. Methods: Thirty C57BL/6 mice were divided into control group, AP group and resolvin D1 group. AP model was established by intraperitoneal injection of cerulein at 50 μg·kg^-1·h^-1. Resolvin D1 was intraperitoneally given at 50 μg/kg one hour before and four hours after modeling. The mice of control group were intraperitoneally injected the same volume of 0.9% sodium chloride solution. The serum levels of amylase and lipase were measured by colorimetric method. The pathological injury of the lung and pancreatitis were observed under optical microscope. Autophagic vacuoles in acinar cells of pancreas of mice were evaluated by transmission electron microscope. And the expressions of autophagy related markers Beclin-1, p62 and LC3-Ⅱ at the mRNA and protein levels in pancreas of mice were detected by real time quantitative polymerase chain reaction (RT-qPCR) and Western blotting method. One-way analysis of variance and SNK-q were performed for statistical analysis. Results: There were statistically significant differences in serum amylase and lipase levels between control group, AP group and resolvin D1 group (F=62.99 and 149.69, both P<0.01). The serum amylase and lipase levels of mice in resolvin D1 group were lower than those of AP group ((525.08±41.12) U/L vs. (752.62±42.03) U/L, (758.24±134.77) U/L vs. (1 201.06±112.53) U/L), and the differences were both statistically significant (both SNK-q test and P<0.01). In addition, there were statistically significant differences in the ratio of the pancreas and lung wet mass to body mass between control group, AP group and resolvin D1 group (F=11.36 and 18.51, both P<0.05). Pathological injury scores of pancreas and lung of resolvin D1 group were both lower than those of AP group (3.3±0.6 vs. 5.6±0.6, 5.4±0.5 vs. 8.8±0.4), and the differences were statistically significant (both SNK-q test and P<0.05). The results of transmission electron microscopy observation revealed that the number of autophagic vacuole of resolvin D1 group was less than that of AP group, and the size was smaller. Moreover, there were statistically significant differences in Beclin-1, p62 and LC3-Ⅱ mRNA between control group, AP group and resolvin D1 group (F=270.95, 151.83 and 124.77, all P<0.05). The relative expression mRNA levels of Beclin-1, p62 and LC3-Ⅱ of resolvin D1 group were 1.59±0.12, 2.75±0.27 and 1.34±0.14, respectively, which were lower than those of AP group (2.68±0.13, 3.32±0.30 and 3.37±0.26, respectively), and the differences were statistically significant (all SNK-q test and P<0.05). There were statistically significant differences in the expressions of Beclin-1, p62 and LC3-Ⅱat the protein level between control group, AP group and resolvin D1 group (F=116.63, 384.40 and 192.45, all P<0.05). The expressions of Beclin-1, p62 and LC3-Ⅱ at protein level of resolvin D1 group were 0.98±0.03, 0.57±0.04 and 0.31±0.03, respectively, which were lower than those of AP group (1.34±0.07, 1.02±0.03 and 0.48±0.04, respectively), and the differences were statistically significant (all SNK-q test and P<0.05). Conclusion Resolvin D1 ameliorates the severity of AP by attenuating the impaired autophagy and restoring autophagic flux in AP mice.

[ ABSTRACT] AIM:To investigate the role of the Notch pathway in Toll-like receptor 4 ( TLR4 )-mediated in-flammatory response in renal ischemia reperfusion injury ( IRI) in rats.METHODS: A total of 75 male sprague-Dawley rats were randomly divided into sham operation group , IRI group and DAPT treatment group .Blood samples and the kid-neys were obtained at 6 h, 12 h, 24 h, 48 h and 72 h after reperfusion .The concentrations of blood urea nitrogen ( BUN) and serum creatinine (Scr) were measured.The serum levels of tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were detected by ELISA, and the expression of Notch1, TLR4 and NF-κB p65 in the renal tissues was assessed by im-munohistochemistry and Western blot .RESULTS: The serum levels of BUN, Scr, TNF-αand IL-6 in IRI group were markedly increased as compared with sham group (P<0.05).The protein levels of Notch1, TLR4 and NF-κB p65 in re-nal tubular epithelial cells in IRI group was significantly enhanced as compared with sham group ( P<0.05 ) .In DAPT group, the serum levels of BUN, Scr, TNF-αand IL-6 were significantly reduced compared with IRI group (P<0.05), and the protein levels of Notch1, TLR4 and NF-κB p65 were apparently less than those in IRI group (P<0.05).CON-CLUSION:Significant changes of renal function , a rise of serum inflammatory factor including TNF-αand IL-6 and en-hanced expression of Notch 1, TLR4 and NF-κB p65 in the renal tissue occurred in the rats with IRI .γ-Secretase inhibitor DAPT attenuates TLR4-mediated inflammatory response in the renal IRI through the inhibition of Notch 1 and down-regula-tion of NF-κB.

Aim To investigate whether Hcy influenced the intestinal mucosal permeability by regulating MEK-ERK-MLCK pathway. Methods SD rats were divided into 4 groups:normal group, normal+Hcy group, TN-BS/ethanol group, TNBS/ethanol+Hcy group. Experi-mental colitis model with hyperhomocystinemia was es-tablished in rats with intracolonic administration of TN-BS and subcutaneous injection of Hcy. The colonic mucosal tissue was collected for histopathological exam-ination and activity of myeloperoxidase ( MPO ) . The protein expression of MLCK, p-MLCK, MEK, ERK and p-ERK in intestinal mucosal tissues was examined by Western blot method. The mRNA expression of ML-CK was examined by RT-qPCR method. Result Com-pared with the normal group and TNBS group, the DAI and HI scores and the MPO activity were increased in TNBS/ethanol+Hcy group ( P <0. 01 ) . Western blot and RT-qPCR showed that expression of MLCK, p-ML-CK, MEK, ERK and p-ERK increased in small intes-tine in TNBS/ethanol+Hcy group. Conclusion Hcy can increase intestinal permeability in TNBS-induced colitis rats by regulating the expression of MEK-ERK-MLCK signal pathway.

[ ABSTRACT] AIM:To investigate the expression of calprotectin ( CALP) in the rats with renal ischemia-reperfu-sion injury ( IRI) .METHODS:Male Sprague-Dawley rats were randomly divided into sham operation and IRI group ( n=25 in each group) .Blood samples and the kidneys were obtained at 6 h, 12 h, 24 h, 48 h and 72 h after reperfusion.The pathological changes of the kidneys were observed.The serum concentrations of blood urea nitrogen ( BUN) and serum cre-atinine (SCr) were measured.The serum levels of CALP, tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were detected by ELISA, and the expression of CALP, Toll-like receptor 4 ( TLR4) and NF-κB p65 in the renal tissues were de-termined by the methods of immunohistochemistry and Western blot.RESULTS: Different serial ischemia changes were observed in the renal tissues, mainly in the renal tubular epithelial cells and the mesenchyma, with the infiltration of in-flammatory cells.The serum levels of BUN, SCr, CALP, TNF-αand IL-6 in IRI group were markedly increased as com-pared with sham group (P<0.05).The protein expression of CALP, TLR4 and NF-κB p65 in the renal tubular epithelial cells in IRI group was greatly enhanced in comparison with that in sham group ( P<0.05) .CONCLUSION:The serum concentrations of CALP, TNF-αand IL-6, and the protein expression levels of CALP, TLR4 and NF-κB p65 in the renal tissue are significantly increased in the rats with IRI, suggesting that calprotectin plays an important role in the inflamma-tion in rats with IRI.

Objective To analyze the clinical effects of individualized comprehensive physiotherapy interventions for temporomandibular disorders (TMD).Methods Data of 307 patients with TMD treated between April 2011 and March 2012 in the authors' department were collected and reviewed.All the patients were treated with individualized comprehensive physiotherapy approach based on the patient's category in research diagnostic criteria for TMD (RDC/TMD),such as patient education,ultrashort-wave diathermy,ultrasound therapy,soft tissue massage,joint mobilization and stabilization exercise.The treatment was administered for 3 weeks.The baseline and endpoint outcome assessment measures were maximum active mouth opening (mm),visual analogue scale (VAS) score and joint clicking (100％ before treatment).Results At the end of treatment,the patient's maximum active mouth opening [(36.95 ± 6.59) mm],VAS score (1.21 ± 0.62) and joint clicking [(29 ± 17) ％] improved significantly (P ＜ 0.05) compared to baseline.Conclusions Individualized comprehensive physiotherapy interventions can improve symptoms of TMD,such as joint clicking,pain,limited mouth opening.

Objective To investigate the association between MYO9B rs962917 and rs1545620 gene polymorphism and clinical pathological characteristics of patients with inflammatory bowel disease (IBD) and permeability of intestinal mucosa.Methods From September 2010 to May 2012,a total of 196 cases of patients with IBD were collected,100 cases were ulcerative colitis (UC) and 96 cases were Crohn's disease (CD).At the same time,99 gender and age matched healthy individuals were collected as healthy controls.The 5 mL blood of participants was obtained and DNA was extracted.The MYO9B gene rs962917 and rs1545620 polymorphism was detected by polymerase chain reaction (PCR) and ligase detection reaction (LDR).After 60 patients with UC and 58 patients with CD orally took intestinal permeability testing fluid (with lactulose and mannitol),the urine of the patients was analyzed with high pressure liquid chromatography-pulsed lectrochemical dection (HPLC-PED).The permeability of intestinal mucosa was determined according to the ratio of lactulose and mannitol.Chisquare test was used for count data.Results Compared with healthy control group,there was no significant difference in genotype and allelic gene distribution of MYO9B rs962917 and rs1545620 of IBD group,UC group and CD group (all P＞0.05).The genotype of MYO9B rs962917 and rs1545620 of patients with UC was not related with the disease activity and location of lesions (rs962917:x2 =0.481 and 3.812,rs1545620..x2 =0.398 and 4.543 ;all P＞0.05).The genotype of MYO9B rs962917 of patients with CD was not related with the disease activity,lesion type and occurrence of perianal lesions (x2 =0.384,0.476 and 3.486,all P＞0.05) and was related with location of lesions (x2=15.926,P＜0.05).The genotype of MYO9B rs1545620 of patients with CD was not related with the disease activity and lesion type (x2 =1.407 and 5.126,both P＞0.05),however was related with location of lesions and occurrence of perianal lesions (x2 =18.165 and 7.629,both P＜0.05).The permeability of intestinal mucosa of all 58 patients with CD was high.The genotype of MYO9B rs962917 and rs1545620 of patients with UC was not related with the permeability of intestinal mucosa (x2=1.508 and 1.025,both P ＞ 0.05).Conclusion MYO9B rs962917 and rs1545620 gene polymorphism is related with the location of lesions in CD and is not related with the permeability of intestinal mucosa of patients with UC.