BACKGROUND:The specific mechanism of Gushukang,as a Chinese traditional patent medicine for the treatment of postmenopausal osteoporosis of kidney deficiency and blood stasis,needs further studies. OBJECTIVE:To investigate the effect of Gushukang on serum sex hormones,bone microstructure and estrogen receptor in postmenopausal osteoporosis. METHODS:Firstly,network pharmacological analysis was performed.The active ingredients and action targets of Gushukang and the targets of postmenopausal osteoporosis were obtained respectively.Cytoscape was used to construct the active ingredient-target network.STRING database and Cytoscape were used for protein-protein interaction analysis and screening of core targets.DAVID database was used for Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses of intersection targets.Then the ovariectomized Sprague-Dawley rats were used in the animal experiment.Gushukang was administered by gavage for 3 months.The serum estrogen level was detected by ELISA,the bone microstructure was detected by microCT,and the protein expression of estrogen receptor α and estrogen receptor β in bone tiusse was detected by western blot. RESULTS AND CONCLUSION:The network pharmacological research results identified 132 active ingredients and 150 targets of Gushukang and 1155 targets of postmenopausal osteoporosis.After intersections with 1155 postmenopausal osteoporosis targets,87 targets of active ingredients of Gushukang against postmenopausal osteoporosis were obtained.By constructing the active ingredient-target network,it was found that the active ingredients at the core were quercetin,kaempferol,luteolin,naringin and isorhamnetin,and the targets at the core were NCOA2,ESR2,AR,F2,ESR1 and PTGS1.The final targets obtained after the protein-protein interaction analysis and screening included MAPK8,ESR1,JUN,R3C1,RELA and FOS,of which ESR1 was the common core target obtained from the two analyses.KEGG enrichment analysis showed estrogen,tumor necrosis factor,apoptosis and other signaling pathways.Therefore,animal experiments focused on the effect of Gushukang on different subtypes of estrogen receptors in the estrogen signaling pathway.The results showed that in the Gushukang group,bone microstructure was significantly improved,serum estrogen level had no significant change,but the protein expression of estrogen receptor α and β in bone tissue was significantly increased.All the findings indicate that the mechanism of Gushukang in the treatment of postmenopausal osteoporosis may be related to its hormone-like effect and the enhancement of estrogen receptor expression.

Objective:To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction.Methods:This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them.Results:No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group ( Z=-4.511, P<0.01). Conclusions:Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Objective:To compare the therapeutic effects of modified plantar skin grafting and thigh skin grafting on the deep burn wounds of the back and buttocks.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with deep burn wounds on their back and buttocks who were admitted to the 910th Hospital of Joint Logistic Support Force of PLA from January 2021 to April 2023, including 26 males and 4 females, aged 21-72 years [(49.9±14.0)years]. The total burn size was 50%-97% of the total body surface area (TBSA), with the third-degree burn on the back and buttocks 6%-16% TBSA. The burn wounds on the back and buttocks were repaired using plantar skin grafts alone, thigh skin grafts alone or plantar skin grafts combined with the grafts from other body parts. The patients were grouped according to the skin graft donor sites and the times of harvesting skin grafts: there were 20 patients undergone plantar skin grafting including 10 patient with plantar skin graft harvested once (group of plantar skin graft harvested once) and 10 patients with plantar skin graft harvested twice or three times (group of plantar skin graft harvested more than once), and 10 patients undergone thigh skin grafting harvested once (group of thigh skin graft harvested once). The areas of plantar skin grafts harvested at the last time and the wound areas on the back and butts that could be repaired each time were calculated. After the last harvest, the thickness of the stratum corneum, 7-day survival rate of the skin grafts, proportion of 3-month residual wound area in the skin graft area, healing time of the donor sites, and 6-month Vancouver Scar Scale (VSS) scores of the donor sites in the group of plantar skin graft harvested once were compared with those in the group of thigh skin graft harvested once and the group of plantar skin graft harvested more than once. The appearance and texture of the skin graft, patients′ walking patterns and complications were observed at 6 months after the last skin harvest.Results:All the patients were followed up for 6-18 months [(7.8±1.6)months]. In the 20 patients with plantar skin grafts harvested, the areas of skin grafts harvested at the last time were 2.5%-4.5% TBSA [(3.4±0.6)% TBSA] and the wound areas that could be repaired each time were 3%-8% TBSA [(5.5±1.5)% TBSA]. After the last harvest, the thickness of the stratum corneum in the group of plantar skin graft harvested once was (190.4±8.9)μm, which was significantly thicker than that in the group of thigh skin graft harvested once [(50.0±6.6)μm] and that in the group of plantar skin graft harvested more than once [(166.8±21.9)μm] ( P<0.01); the 7-day survival rate of the skin grafts, proportion of 3-month residual wound area in the skin graft area, healing time of the donor sites, and 6-month VSS scores of the donor sites were (93.6±2.3)%, 2.0 (0.1, 3.5)%, (9.9±1.8)days and (1.7±0.7)points in the group of plantar skin graft harvested once, (78.0±6.6)%, 5.3 (4.0, 5.8)%, (14.0±1.4)days and (4.9±2.3)points in the group of thigh skin graft harvested once, and (93.4±2.6) %, 2.0 (0.1, 3.8)%, (10.0±1.2)days and (1.8±0.8)points in the group of plantar skin graft harvested more than once. The group of plantar skin graft harvested once showed a significant increase in the 7-day survival rate and a significant decrease in the proportion of 3-month residual wound area in the skin graft area, healing time of the donor sites, and 6-month VSS scores of the donor sites in comparison with the group of thigh skin graft harvested once ( P<0.05 or 0.01), while there were no significant differences in above mentioned indices between the group of plantar skin graft harvested once and the group of plantar skin graft harvested more than once ( P>0.05). At 6 months after the last skin harvest, the skin graft areas on the back and buttocks were flat, hard and firm and all the patients in the three groups could walk normally, with no complications such as severe itching, pain or folliculitis in the skin graft area. Conclusions:In the treatment of burn wounds on the back and buttocks, compared with thigh skin grafting, modified plantar skin grafting has advantages of thicker stratum corneum, better wear resistance and pressure resistance in the skin graft areas, a higher survival rate of skin grafts, rapid healing, mild scar, and undisturbed walking pattern after surgery and no common complications. Moreover, skin grafts can be harvested repeatedly from the donor sites, with no impact on the therapeutic effects.

Objective:To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction.Methods:This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them.Results:No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group ( Z=-4.511, P<0.01). Conclusions:Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Objective:To compare the short-term clinical efficacy and patient satisfaction of single-port assisted endoscopic breast-conserving surgery versus open approach in the treatment of female breast cancer patients.Methods:This study retrospectively analyzed the clinical data of 129 female breast cancer patients admitted to Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University from March 2022 to June 2023. In this study, 56 patients underwent breast-conserving surgery assisted by single-port endoscopy (endoscopic group) and 73 patients underwent conventional open breast-conserving surgery (conventional group).Results:Compared to the conventional group (73 cases), the endoscopic group (56 cases) had slightly longer operation time [(200.0±43.2) min vs. (185.3±56.5) min] and intraoperative blood loss [(34.0±25.4) ml vs. (27.2±21.8) ml, P>0.05]. The endoscopic group had a significantly shorter surgical incision length than the conventional group [(4.7±0.7) cm vs. (8.0±1.1) cm, P<0.05], the difference in postoperative tumor margin was not significant (endoscopic group: 3.5% vs. conventional group: 5.7%, P>0.05). In terms of postoperative complications, the endoscopic group had a significantly lower incidence of radiation-related skin reactions than the conventional group ( P<0.05). The endoscopic group had a higher satisfaction rate in terms of postoperative aesthetics (73.2% vs. 56.2%, P<0.05). Conclusions:The short-term clinical efficacy of breast-conserving surgery for female breast cancer by single-port assisted endoscopy is not inferior to that of conventional open breast-conserving surgery, with added better cosmetic results.

Objective:To evaluate artificial intelligence constructed by deep convolutional neural network (DCNN) for the site identification in upper gastrointestinal endoscopy.Methods:A total of 21 310 images of esophagogastroduodenoscopy from the Cancer Hospital of Chinese Academy of Medical Sciences from January 2019 to June 2021 were collected. A total of 19 191 images of them were used to construct site identification model, and the remaining 2 119 images were used for verification. The performance differences of two models constructed by DCCN in the identification of 30 sites of the upper digestive tract were compared. One model was the traditional ResNetV2 model constructed by Inception-ResNetV2 (ResNetV2), the other was a hybrid neural network RESENet model constructed by Inception-ResNetV2 and Squeeze-Excitation Networks (RESENet). The main indices were the accuracy, the sensitivity, the specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:The accuracy, the sensitivity, the specificity, PPV and NPV of ResNetV2 model in the identification of 30 sites of the upper digestive tract were 94.62%-99.10%, 30.61%-100.00%, 96.07%-99.56%, 42.26%-86.44% and 97.13%-99.75%, respectively. The corresponding values of RESENet model were 98.08%-99.95%, 92.86%-100.00%, 98.51%-100.00%, 74.51%-100.00% and 98.85%-100.00%, respectively. The mean accuracy, mean sensitivity, mean specificity, mean PPV and mean NPV of ResNetV2 model were 97.60%, 75.58%, 98.75%, 63.44% and 98.76%, respectively. The corresponding values of RESENet model were 99.34% ( P<0.001), 99.57% ( P<0.001), 99.66% ( P<0.001), 90.20% ( P<0.001) and 99.66% ( P<0.001). Conclusion:Compared with the traditional ResNetV2 model, the artificial intelligence-assisted site identification model constructed by RESENNet, a hybrid neural network, shows significantly improved performance. This model can be used to monitor the integrity of the esophagogastroduodenoscopic procedures and is expected to become an important assistant for standardizing and improving quality of the procedures, as well as an significant tool for quality control of esophagogastroduodenoscopy.

Objective Network pharmacology and molecular docking and molecular dynamics techniques were used to investigate the mechanism of action of Alhagi sparsifolia Shap.in the treatment of sepsis and to perform animal experimental verification.Methods First,we screened the effective ingredients and their action targets of Alhagi sparsifolia Shap.,meanwhile,screened relevant action targets for the treatment of sepsis,constructed a protein interaction(PPI)network,and performed topology analysis to draw a TCM disease target network diagram.Second,Kyoto Encyclopedia of genes and genomes enrichment analysis was performed for core targets in the network diagram,along with gene ontology functional enrichment analysis.This was followed by molecular docking and molecular dynamics simulation experiment validation of the core targets.Finally,mice were used for the verification of animal experiments.Results Thirty active components of Alhagi sparsifolia Shap.were screened out,and the top 5 ranked by degree value were quercetin,(-)-epigallocatechin,(-)-Epigallocatechin Gallate,genistein,kaempferol and epigallocatechin with 196 action targets;2144 disease-related targets for sepsis,105 targets for Alhagi sparsifolia Shap.-sepsis intersection,and the core targets were TNF,IL-6,AKT1,VEGFA,CASP3,IL-1β Et al.PI3K-Akt,TNF,HIF-1,AGE-RAGE,IL-17 and other signaling pathways are involved to mediate inflammatory responses,apoptosis and other biological processes to exert therapeutic effects on sepsis.Molecular docking results showed that camelina flavanoids bound equally well to each key target,among which the conformations with the lowest binding energy were(-)-Epigallocatechin Gallate-IL-6 and quercetin-IL-6.Molecular dynamics simulations were performed on the two pairs of complexes,and the results indicated that the stable binding could be achieved through a combination of electrostatic,van der Waals potential,and hydrogen bonding interactions.Animal experiments confirmed that Alhagi sparsifolia Shap.could inhibit the activation of PI3K/Akt signaling pathway,decrease the protein expression of Caspase-3,VEGF and reduced peripheral blood inflammatory factors secretion of TNF-α、IL-1βand IL-6,alleviating inflammatory injury in tissues and organs.Conclusion The therapeutic effect of Alhagi sparsifolia Shap.on sepsis is achieved through multi biological processes,multi targets,and multi pathways.It provides a certain theoretical basis for the clinical application of camel spines as well as sepsis treatment.

Objective:To explore the clinical effects of plantar split-thickness skin grafts in repairing the deep burn wounds in the back and buttocks.Methods:A retrospective observational study was conducted. From January 2011 to February 2022, 98 patients with deep burn who met the inclusion criteria were admitted to the 910 th Hospital of Joint Service Support Unit of PLA, including 64 males and 34 females, aged 17 to 78 years, with total burn areas of 35%-95% total body surface area (TBSA). The area of full-thickness burns in the back and buttocks ranged from 5% to 17% TBSA and the wounds were repaired only using stamp-shaped split-thickness skin grafts from plantar areas of both feet or combined with Meek microskin grafts or stamp-shaped skin grafts from other sites. According to the times of skin graft harvesting from both soles, these patients were divided into one-harvesting group (29 cases), two-harvesting group (38 cases), three-harvesting group (21 cases), and four-harvesting group (10 cases). The area of skin grafts harvested each time from both soles, the healing time of donor sites after each skin graft harvesting, and the survival rate of plantar skin graft in recipient site at 7 days after each skin graft harvesting in 98 patients, the interval between two adjacent skin graft harvesting in 69 patients with skin grafts harvested twice or more, as well as the healing time of donor site and survival rate of skin graft in recipient site after the last skin graft harvesting from both soles of patients in the 4 groups were recorded. The patients were followed up to observe the appearance, texture, and scar in recipient site of plantar skin grafts as well as the scar and function in plantar donor sites. Data were statistically analyzed with one-way analysis of variance, Kruskal-Wallis test, and chi-square test. Results:In the 98 patients, the area of skin graft was 2.0%-4.5% ((3.4±0.6)%) TBSA harvested each time from both soles, the healing time of donor site after each skin graft harvesting was 7-10 (7.8±1.1) d, and the survival rate of plantar skin graft in recipient site at 7 days after each skin graft harvesting was 93% (92%, 95%). The interval between two adjacent skin graft harvesting in the 69 patients was 7-38 (11.2±0.5) d. The healing time of donor site and survival rate of skin graft in recipient site after the last skin graft harvesting from both soles of patients in the 4 groups showed no statistically significant differences ( P>0.05). A total of 88 patients were followed up for 3 months to 5 years, the appearance in recipient site of plantar skin graft was smooth, the texture was firm, the scar hyperplasia was mild, and the area was compressive- and wear-resistant. Among them, the plantar donor site recovered well in 85 patients, without obvious scar hyperplasia and only 3 patients had small area of scar hyperplasia in the non-weight-bearing areas which did not affect walking or wearing shoes or socks. Ten patients were lost in the follow up after discharge. Conclusions:Stamp-shaped split-thickness skin grafts can be repeatedly harvested from both soles of patient to repair the deep burn wounds in the back and buttocks, with high survival rate of skin grafts, thus can reduce the burden of other donor sites. Moreover, the skin grafts have good wear-resistance and pressure-resistance, without affecting postoperative normal walk.

Objective:To investigate the variation trend of peripheral blood CD34 + cells during the hematopoietic stem cell mobilization and its influence on the collection timing and results. Methods:The clinical data of 62 patients with hematologic diseases undergoing autologous peripheral blood hematopoietic stem cell mobilization from April 2012 to March 2017 in Shanxi Provincial Cancer Hospital were analyzed. Mobilization regimen used chemotherapy combined with granulocyte colony-stimulating factor (G-CSF) to monitor the number of white blood cells (WBC), mononuclear cells (MNC), CD34 + cells in peripheral blood and apheresis concentrates, and the correlation with CD34 + cells was analyzed. Furthermore, the receiver operating characteristic (ROC) curve was used to establish the threshold to start apheresis. Results:MNC (5.66±1.11)×10 8/kg and CD34 + cell count (2.15±1.20)×10 6/kg were obtained in 62 patients who received 136 times collection in total. The peak of peripheral blood CD34 + cells count appeared at day 4-5 after the treatment of G-CSF, and then it went down. CD34 + cell count in the product was correlated with the peripheral blood CD34 + cell count collected on the day ( r = 0.879, P < 0.01), and it was also correlated with the peripheral blood WBC and MNC collected on the day as well as MNC count in the product (all P < 0.05). Furthermore, the ROC curve analysis demonstrated that peripheral blood CD34 + cells count > 23/μl was the optimal threshold for stem cell collection on the day, 85.2% of patients reaching up to the threshold could be successfully collected at one time. Conclusions:The variation trend of peripheral blood CD34 + cell count can guide the best time of stem cell collection in clinic. Peripheral blood CD34 + cell count is the reliable index to predict CD34 + cells count in the products. Peripheral blood CD34 + cells count > 23/μl could be used as the collection threshold.

Objective:To investigate the effect of infused CD34 + cell count on hematopoietic recovery and prognosis of non-Hodgkin lymphoma (NHL) patients after autologous peripheral blood hematopoietic stem cell transplantation (APBSCT). Methods:The data of 60 NHL patients who underwent APBSCT from May 2010 to May 2016 in the Affiliated Cancer Hospital of Shanxi Medical University was retrospectively analyzed, including 32 B-NHL patients and 28 T-NHL patients. The patients were grouped according to the receiver operating characteristic curve (ROC) threshold, and the hematopoietic reconstruction after transplantation was analyzed. The relationship between the infused CD34 + cell count and prognosis was analyzed. The prognostic factors were analyzed using univariate and multivariate analyses. Results:The CD34 + cell count threshold was determined to be 4.35×10 6/kg based on ROC. In CD34 + cell count≥ 4.35×10 6/kg group (20 cases) and CD34 + cell count < 4.35×10 6/kg group (40 cases), the granulocyte recovery time was (9.9±1.2) d and (12.5±3.7) d ( P = 0.031), and the platelet recovery time was (9.4±1.7) d and (13.8±2.9) d ( P = 0.012). The 3-year overall survival(OS) rates in CD34 + cell count ≥ 4.35×10 6/kg group and CD34 + cell count < 4.35×10 6/kg group were 85.0% and 55.0% ( P = 0.024), and the 3-year PFS rates were 85.0% and 57.5% ( P = 0.016). In B-NHL patients, the 3-year PFS rates in CD34 + cell count ≥ 4.35×10 6/kg group (11 cases) and CD34 + cell count < 4.35×10 6/kg group (21 cases) were 81.8% and 42.9% ( P = 0.037), respectively. In T-NHL patients, the 3-year OS rates in CD34 + cell count ≥ 4.35×10 6/kg group (9 cases) and CD34 + cell count < 4.35×10 6/kg group (19 cases) were 77.8% and 36.8% ( P = 0.049), respectively. Univariate survival analysis showed that the predictive factors of both OS and PFS included age > 60 years old, Ann Arbor stage Ⅲ-Ⅳ, international prognostic index (IPI) score > 2 and infused CD34 + cell count < 4.35×10 6/kg (all P < 0.05). Multivariate analysis showed that IPI score and infused CD34 + cell count were both independent predictive factors of PFS ( RR = 0.333, 95% CI 0.112-0.994, P = 0.049; RR = 0.190, 95% CI 0.047-0.773, P = 0.020), and IPI score was an independent predictive factor of OS ( RR = 0.095, 95% CI 0.011-0.837, P = 0.034). Conclusion:The infused CD34 + cell count affects the hematopoietic reconstruction time and component blood transfusion after APBSCT, and has certain predictive value for the prognosis of NHL patients.