YE Tianshi possessed a comprehensive theoretical system and extensive therapeutic experience in the treatment of warm disease caused by latent pathogenic qi,all of which was recorded in his medical records.YE Tianshi elucidated the characteristics of the pathogenesis of the three types of warm disease caused by latent pathogenic qi,namely spring warmth,summer heat,and winter warmth,and explained the pathogenesis of latent pathogenic qi from the perspective of vital qi and pathogen,and pointed out that the weakness of vital qi and the pathogenic qi led to the concealment of pathogenic qi,and that the struggle between vital qi and pathogen led to the onset of latent pathogenic qi.In the treatment,YE Tianshi emphasized the importance of clearly identifying the level of qi and blood in the internal organs where the latent pathogenic qi is located,and focused on the syndrome differentiation of weifen,qifen,yingfen,and xuefen,and combined with the syndrome differentiation of zang-fu viscera,the principle and method of treatment and medication law of warm disease caused by latent pathogenic qi were formulated.Although warm disease caused by latent pathogenic qi is a heat syndrome,YE Tianshi also attached importance to the deficiency and excess of yang qi,pointed out that latent pathogenic qi had the possibility of transforming into cold syndrome,and discussed the rules of medication for cold latent pathogenic qi in the spleen,kidney,and eight extraordinary meridians.YE Tianshi's treatment of warm disease caused by latent pathogenic qi not only emphasizes the nourishment of yin,but also emphasizes clearing qi and blood,and the circulation of qi in order to clear and penetrate the evil qi;he also pays attention to the sanjiao transmission of the latent pathogenic evil.The study of the law of YE Tianshi's differentiation and treatment of warm disease caused by latent pathogenic qi may provide ideas for the clinical treatment of COVID-19,as well as diseases in various disciplines.

Objective:High-throughput screening to obtain small molecular compounds against Gram-negative bacilli by targeting BamA outer membrane protein.Methods:The sybyl-X2.1 software was used to perform high-throughput virtual screening of small molecular compounds in Chemdiv compound library based on the molecular docking. The top 150 hits by high-throughput screening were re-screened through in vitro biological experiments. The top 4 small molecules with obvious antibacterial activity were selected for in-depth molecular docking analysis, and the small molecule 8308-0401 with the highest docking score was selected for further experiments. The antibacterial effect of 8308-0401 combined with rifampicin was tested by checkerboard assay. Finally, the affinity between 8308-0401 and BamA was tested by plasma surface resonance assay. Results:The docking score of the top 150 hits calculated by high-throughput virtual screening had a mean value of 5.63. In vitro biological experiments showed that small molecules 8308-0401, 8365-1335, C066-2507 and L582-0346 exhibited strong antibacterial activity. Among those molecules, 8308-0401 showed the highest molecular docking score, and synergistic antibacterial activity against both types of strains and clinical isolates when combined with rifampicin. 8308-0401 has a strong affinity to BamA with binding a constant of 182 μmol/L. Conclusion:The small molecule 8308-0401 exerts antibacterial activity against Gram negative bacilli by targeting the outer membrane protein BamA.

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

ObjectiveTo investigate the effects and underlying mechanism of Yinxing Mihuan oral solution （YM） on neovascularization and vascular remodeling in chemical photothrombosis-induced focal cerebral ischemia model in mice. MethodFifty SPF C57BL/6J mice were randomly divided into sham group， model group， ginaton group （12.5 mg·kg^-1）， and low- （YM-L， 412 mg·kg^-1） and high-dose （YM-H， 824 mg·kg^-1） YM groups， with 10 mice in each group. The focal cerebral ischemia model was established by chemical photothrombosis method. Drugs in each group were administered by gavage for 14 consecutive days after operation. The modified neurological severity score （mNSS） and measurement of forelimb grasping were used to evaluate the neurologic impairment of mice. The vascular density of infarct border-zone （IBZ） was measured by fluorescein labelled dextran （FITC-dextran） method. The morphology of IBZ was evaluated and observed by hematoxylin-eosin （HE） staining. The expression of proteins related to neovascularization and vascular remodeling in brain tissues， including vascular endothelial growth factor （VEGF）， platelet and endothelial cell adhesion molecule 1 （CD31）， hypoxia-inducible factor-1α （HIF-1α）， von Willebrand factor （vWF）， and angiogenin （ANG）， was detected by Western blot. ResultCompared with the sham group， the model group showed manifest neurological deficits （P<0.01）， weakened forelimb grasping （P<0.01）， increased vascular density of IBZ （P<0.01）， and obvious pathological changes， such as neuronal necrosis and gliocyte proliferation. After treatment for 14 days， compared with the model group， the YM-H group showed improved neurological deficits （P<0.01）， and the YM-L group and the YM-H group showed strengthened forelimb grasping （P<0.01）. Moreover， the YM-L group displayed increased vascular density of IBZ （P<0.05）， reduced pathological damage， and up-regulated protein expression of CD31， ANG， HIF-1α， and vWF （P<0.05， P<0.01）. ConclusionYM could improve motor function and pathological morphological impairment in chemical photothrombosis-induced focal cerebral ischemia mouse model， and the underlying mechanism might be related to the promotion of neovascularization and vascular remodeling in IBZ.

The widespread application of next generation sequencing (NGS) in clinical settings has enabled testing, diagnosis, treatment and prevention of genetic diseases. However, many issues have arisen in the meanwhile. One of the most pressing issues is the lack of standards for reporting genetic test results across different service providers. The First Forum on Standards and Specifications for Clinical Genetic Testing was held to address the issue in Shenzhen, China, on October 28, 2017. Participants, including geneticists, clinicians, and representatives of genetic testing service providers, discussed problems of clinical genetic testing services across in China and shared opinions on principles, challenges, and standards for reporting clinical genetic test results. Here we summarize expert opinions presented at the seminar and report the consensus, which will serve as a basis for the development of standards and guidelines for reporting of clinical genetic testing results, in order to promote the standardization and regulation of genetic testing services in China.

Objective To explore integrated teaching based on small private online course (SPOC) in lymphoma clinical courses for medical undergraduates.Methods A total of 60 medical undergraduates in the department of hematology were randomly allocated to SPOC teaching group (n=30) and problem-based learning (PBL) teaching group (n=30) according to scores of the basic medical theoretical examination for lymphoma clinical courses education.After teaching activities,personal experiences were evaluated by anonymous questionnaires from medical undergraduates and instructors.Besides teaching efficacies assessed by objectively measurable score system including academic examination scores,clinical skill and capabilities in analyzing clinical problems of students,were systematically analyzed and compared between two groups by SPSS 19.0.Results The survey results showed that compared with PBL teaching group,SPOC teaching group had higher teaching feedback evaluation and better teaching experience,and SPOC were widely recognized by teachers and students.The SPOC teaching group's scores of the three items in the exam were better than those of the PBL teaching group,with the academic achievement [(84.03 ± 7.66) vs.(77.60 ± 8.22),P=0.005],the performance of practical skills [(87.83 ± 8.17) vs.(81.97 ± 6.13),P=0.001],and case analysis results [(88.17 ± 6.53) vs.(80.10 ± 6.91),P=0.000],and the difference was statistically significant.Conclusion Integrated teaching based on SPOC is feasible for lymphoma clinical courses,which can trigger interest of students,enhance learning abilities and their clinical capabilities.Moreover,this novel medical education approach may provide new ideas and theoretical basis in training qualified and talent doctors.

To date, the efficacy of radical surgery (RS) versus conservative surgery (CS) for liver hydatid cysts (LHC) remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.
Echinococcosis, Hepatic ; mortality ; surgery ; Humans ; Length of Stay ; statistics & numerical data ; Operative Time ; Postoperative Complications ; epidemiology ; Recurrence ; Treatment Outcome

[Objective] To evaluate the effect of hydromorphone for postoperative analgesia on residual carbon dioxide during recovery after laparoscopic colorectal surgery.[Methods] A total of 100 patients performed with elective laparoscopic colorectal surgery were randomly allocated into two groups according to different patient controlled intravenous analgesia (PCIA) formula:Group H contained hydromorphone 8 mg and Group M contained morphine 40 mg.Total PCIA volume was 100 mL saline with loading volume 2 mL,background volume 2 mL/h,and lockout time was set on 15 min.Analgesia infusion pump was used in the two groups half an hour before the end of surgery.Surgery time,pneumoperitoneum time,anesthesia time,extubation time,recovery time and retention time in postanesthesia care unit (PACU) were rccordcd,rcspcctively.PaCO2,the pain Visual Analogue Scale (VAS) score,Ramsay sedation score,at 30 min (T0) after pneumoperitoneum,extubation time (T1),30 min (T2),1 h (T3),2 h (T4),and 24 h (T5) after extubation,the times of PCA compressions were recorded.Anesthesia complications during waking-up period such as postoperative nausea and vomiting (PONV),shoulder pain,hypersomnia,pruritus and satisfaction degree after surgery were also recorded.[Results] Compared with group H,PaCO2 was higher at T2 ～ T4 (P ＜ 0.05);Recovery time,extubation time and the retention time in PACU were longer after surgery (P ＜ 0.05);The incidence of postoperative nausea and vomiting,shoulder pain were higher in group M (P ＜ 0.05).Compared with group M,VAS score at T1 ～ T3,and Ramsay sedation score T1 ～ T4 were decreased in group H (P ＜ 0.05).[Conclusion] Compared with morphine,hydromorphone can increase fewer residual carbon dioxide during recovery and fewer side effects for the patients caused by that after laparoscopic colorectal surgery.Hydromorphone was a safer and more effective analgesic for postoperative analgesia than morphine.

Objective To compare the therapeutic efficacy of combined biliary stent and 125I seed intracavity irradiation with palliative surgery in the treatment of extrahepatic ductal cholangiocarcinoma.Methods A prospective analysis was conducted on 142 patients with cholangiocarcinoma who were treated in The First Affiliated Hospital of Bengbu Medical College from January 2012 to December 2015.There were 80 patients who underwent percutaneous biliary metal stenting combined with 125I particles implantation (the stenting-particle group) and 62 patients who were treated by palliative biliary drainage (the surgical group).The surgical group included R1 resection in 17 patients,R2 resection in 26 patients and biliary enteric drainage in 19 patients).The levels of jaundice,liver function,survival time,hospitalization time and hospitalization cost before and after therapy were analyzed.Results Jaundice was effectively alleviated in the two groups after a short period.The liver function in the 2 groups improved significantly at 1,3 and 6 months when compared with that before operation,(P ＜ 0.05).The average hospitalization time of the stenting-particle group and the surgery group were (16.5 ± 5.0) days and (25.5 ± 10.5) days,respectively,(P ＜ 0.01).The average hospitalization cost of the stenting-particle group and the surgery group were (39 622.0 ± 7 666.4) yuan and (59 562.0 ± 24 218.2) yuan,respectively,(P ＜ 0.05).The average survival time of the stenting-particle group and the surgery group were (12.2 ± 5.1) months and (12.69 ± 7.46) months,respectively,and the difference was not significantly different (P ＞ 0.05).Conclusions For patients with extrahepatic ductal cholangiocarcinoma who were not suitable for radical surgery,percutaneous biliary stenting combined with 125I seed brachytherapy effectively reduced jaundice,improved liver function,shortened average length of hospital stay and reduced average cost of hospitalization.When compared with palliative surgery,it was a minimally invasive,easy,safe and efficacious treatment,especially for elderly patients with poor physical conditions.

Background:Diagnosis of liver cirrhosis in early stage with early intervention may stabilize disease progression, avoiding or delaying the occurrence of decompensation. Seeking non-invasive serum biomarkers is becoming an important topic in the diagnosis and assessment of liver cirrhosis. Aims:To study the value of serum miR-192 and miR-29a as non-invasive biomarkers for the diagnosis of liver cirrhosis. Methods:Differentially expressed serum miRNAs between patients with liver cirrhosis and healthy controls were screened through online literature retrieval and then confirmed by real-time PCR. Serum levels of two confirmed miRNAs,miR-192 and miR-29a were analyzed in 120 patients with liver cirrhosis and 76 healthy volunteers by real-time PCR. A mathematical model of combined detection of miR-192 and miR-29a for diagnosis of liver cirrhosis was established by binary logistic regression. The diagnostic performance of various non-invasive serum indicators was evaluated by ROC curve analysis. Results:Compared with healthy controls,expression level of serum miR-192 in cirrhotic patients was significantly increased and that of serum miR-29a was significantly reduced(P ﹤ 0. 001). The diagnostic performance of risk score obtained from mathematical model of combined detection of serum miR-192 and miR-29a was superior to that of single miRNA detection or other non-invasive serum indicators,such as APRI,FIB-4 and ARR,the areas under ROC curve of the above mentioned indicators were 0. 968,0. 887,0. 933,0. 796,0. 793,and 0. 571,respectively. Serum levels of miR-192,miR-29a and the risk score of their combined detection were significantly correlated with the stage of liver cirrhosis according to the Child-Pugh classification( P ﹤ 0. 05). Conclusions:Serum miR-192,miR-29a and the risk score of their combined detection might be novel non-invasive biomarkers for the diagnosis and assessment of liver cirrhosis.