Objective: To evaluate the efficacy and safety of Jiawei Simiao powder (JWSMP) combined with celecoxib for the treatment of acute gouty arthritis by conducting a meta-analysis of randomized controlled trials (RCTs). Methods: The Chinese National Knowledge Infrastructure Databases, Chinese Scientific Journal Database, Wanfang, Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched from inception until December 2023. Continuous variables were analyzed using the mean difference (MD) for analysis, and dichotomous variables were used as risk ratios. Data with similar characteristics were pooled for meta-analysis, and heterogeneity was assessed using I2. The Cochrane Handbook was used to assess the risk of bias and quality. RevMan 5.3 software was used to perform the meta-analysis. Results: Thirteen RCTs involving 1007 patients were included in the study. The quality of the included studies was low (unclear randomization processes and insufficient blinding reporting). The group receiving JWSMP combined with celecoxib showed significantly lower levels of serum uric acid (SUA, MD = −66.32, 95% confidence interval (CI): −80.97 to −51.67, P < .001), erythrocyte sedimentation rate (ESR, MD = −6.05, 95% CI: −8.29 to −3.82, P < .001), C-reactive protein (CRP, MD = −7.39, 95% CI: −11.15, −3.63, P < .001), and joint pain score (VAS score, MD = −2.14, 95% CI: −2.4 to −1.88, P < .001) compared to celecoxib alone. Additionally, the JWSMP combined group had a higher total effective rate (risk ratio = 1.22, 95% CI: 1.14 to 1.29, P < .001) and fewer adverse compared to celecoxib alone. Conclusions JWSMP combined with celecoxib is more effective than celecoxib alone in improving the total efficacy rate, alleviating joint pain, and improving SUA, ESR, and CRP levels. JWSMP also reduced the occurrence of adverse events caused by celecoxib. However, the quality of the included studies was low, highlighting the need for further high-quality research with larger sample sizes and robust methodologies, such as double-blind randomization, to confirm these findings.

ObjectiveTo explore the material basis of bile-processed Coptidis Rhizoma clearing excessive fire of liver-gallbladder based on ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF/MS） metabolomics and molecular docking. MethodUPLC-Q-TOF/MS metabolomics was used to analyze the chemical constituents of Coptidis Rhizoma， water-processed Coptidis Rhizoma and bile-processed Coptidis Rhizoma. Chromatographic separation was achieved with 0.1% formic acid aqueous solution（A）-acetonitrile（B） as the mobile phase in gradient elution（0-2 min， 5%B； 2-20 min， 5%-65%B； 20-40 min， 65%-10%B； 40-45 min， 10%B； 45-46 min， 10%-95%B； 46-49 min， 95%B）， and electrospray ionization（ESI） was applied and operated in positive and negative ion modes， the acquisition range was m/z 80-1 200. Based on this， partial least squares-discriminant analysis（PLS-DA） and variance analysis were used to screen the differential compounds among the three products of Coptidis Rhizoma. Network pharmacology and molecular docking were used to verify the degree of association between differential compounds and excessive fire of liver-gallbladder syndrome. ResultA total of 33 chemical constituents were identified， including 2 phenolic acids， 5 binding bile acids and 26 alkaloids. And 16 differential compounds were identified by multivariate statistical analysis， including 11 alkaloids and 5 binding bile acids. Pathway enrichment analysis in the Kyoto Encyclopedia of Genes and Genomes（KEGG） database yielded 8 pathways related to excessive fire of liver-gallbladder， and the key protein phosphatidylinositol 4，5-bisphosphate 3-kinase catalytic subunit alpha isoform（PIK3CA） was obtained according to the "component-target-pathway" network analysis. Molecular docking results showed that 11 alkaloids had good binding ability with PIK3CA. ConclusionPorcine bile is unique in the processing of bile-processed Coptidis Rhizoma， which can promote the production and dissolution of 11 alkaloids， including berberine and dihydrochelerythrine. Based on the results of molecular docking and reported pharmacological experiments， it can be concluded that 16 different compounds such as berberine， dihydrochelerythrine and taurohyodeoxycholic acid are the material basis of bile-processed Coptidis Rhizoma.

Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.
Humans ; Transcranial Direct Current Stimulation/methods* ; Consciousness Disorders/etiology* ; Brain Injuries/complications* ; Consciousness ; Neuroimaging

Objective:To propose an automatic planning approach for Eclipse15.6 planning system based on Eclipse scripting application programming interface (ESAPI) and evaluate its clinical application.Methods:20 patients with nasopharyngeal carcinoma and 20 cases of rectal cancer were selected in the clinical planning. The developed automatic planning script SmartPlan and RapidPlan were used for automatic planning and dosimetric parameters were compared with manual planning. The differences were compared between two groups by using Wilcoxon signed rank test. Results:The dosimetric results of automatic and manual plans could meet clinical requirements. There was no significant difference in target coverage in nasopharyngeal carcinoma planning between two groups ( P>0.05), and automatic plans were superior to manual plans in organs at risk sparing ( P<0.05). Except for the homogeneity index of PTV and the maximum dose of bowel in rectal cancer plans, the other dosimetric parameters of the automatic plans were better than those of the manual plans (all P<0.05). Conclusions:Compared with the manual plans, the automatic plans have the same or similar target coverage, similar or better protection of organs at risk, and more convenient implementation. The developed SmartPlan based on ESAPI has clinical feasibility and effectiveness.

Objective:To compare the dosimetric parameters and plan complexity between newly-delicated HyperArc (HA) and conventional volumetric-modulated arc therapy (VMAT) in the treatment of brain metastases.Methods:For 26 patients with brain metastases, HA, conventional coplanar (Cop) and non-coplanar (Non-cop) VMAT plans with a prescription dose of 9 Gy 3fx or 6 Gy 5fx were generated. The dosimetric parameters for planning target volume (PTV), RTOG conformity index (RTOG CI), Paddick CI, homogeneity index (HI), gradient index (GI), maximum dose (D max) of brainstem and dose-volume parameters of brain-PTV(V 2Gy-V 26Gy) were statisticaly compared among these three approaches. In addition, the monitor unit (MU) and the plan complexity parameters (including MCSv and AlPO) were statistically compared. Results:To prevent missed targets during treatment, all plans were established with RTOG CI of greater than 1.1. For Paddick CI, HA provided significantly higher conformity (0.89±0.019) than Non-cop (0.87±0.036, P=0.001) and Cop (0.88±0.017, P=0.003) VMAT. For GI, the fastest dose fall-off was noted in HA (3.35±0.64), followed by conventional Non-cop VMAT of (3.70±0.80), and conventional Cop VMAT of (4.90±1.85)(all P<0.05). For the brainstem sparing, HA plan performed better than Non-cop plan[(604.14±531.61) cGy vs.(682.75±558.22) cGy, P<0.05)]. For normal brain tissue sparing, HA approach showed significant reduction than conventional Cop and Non-cop VMAT (both P<0.05). For MU, HA approach (2 872.60 ± 566.93) was significantly lower than those of Non-cop VMAT (3 771.28 ± 1 022.38, P<0.05) and Cop VMAT (4 494.08 ± 1 323.09, P<0.05). In terms of plan complexity, the MCSv of Cop plan was the lowest, indicating that the complexity was the highest ( P<0.05). The AlPO of HA was significantly higher than that of Non-cop VMAT ( P<0.05), suggesting that the complexity of HA plan was lower ( P<0.05). Conclusion:For the treatment of brain metastases, HA provides better conformity, more rapid dose fall-off, better sparing of brainstem and normal brain tissues and less plan complexity compared with conventional VMAT.

Objective:To help clinicians simplify the post-processing operations of structures by developing rapid processing software for target area and organs at risk structures based on ESAPI.Methods:SmartStructure script software was developed based on ESAPI, verified and evaluated in clinical work. 10 cases of rectal cancer receiving neoadjuvant radiotherapy, 10 breast cancer treated with postoperative radiotherapy, 10 cervical cancer receiving postoperative radiotherapy, 10 nasopharyngeal carcinoma receiving radical radiotherapy and 10 lung stereotactic body radiotherapy (SBRT) were selected, and different types of tumors had different post-processing operations of structures. In each case, three methods were used for post-processing of structures. In the control group (manual group), normal manual processing was employed. In the experimental group 1(SmaStru-N group), scripts without templates were utilized. In the experimental group 2(SmaStru-P group). scripts combined with templates were adopted. The processing time of the three methods was compared. Clinicians scored the scripting software from multiple aspects and compared the feeling scores of scripting software and manual operation.Results:All three methods can be normally applied in clinical settings. The error rate in the manual group was 7.0%, 3.0% in the SmaStru-N group 0% in the SmaStru-P group, respectively. Compared with the manual method, SmaStru-N shortened the processing time of target area and organs at risk by 60.9% and 93.3% for SmaStru-P. In addition, SmartStructure was superior to manual method in terms of using feeling scores. Clinicians gave lower score for the" applicability" and" simplicity" , and higher score on the" accuracy" and" efficiency" .Conclusions:Compared with conventional manual structure processing method, SmartStructure software can rapidly and accurately process all structures of the target area and organs at risk, and its advantages become more obvious with the increasing number of structures that need to be processed. SmartStructure software can meet clinical requirements, reduce the error rate, elevate processing speed, improve the working efficiency of clinicians, providing basis for the development of adaptive radiotherapy.

Objective: To investigate the promoting effect of local compression and fixation on the healing of anterior tibial flask-like wound after debridement and suture. Methods: A retrospective case control study was conducted to analyze the clinical data of 57 patients with simple anterior tibial flask-like wound admitted to the Second Hospital of Shandong University from May 2017 to June 2018. There were 32 males and 25 females, aged 20-60 years [(41.4±8.1)years]. The length of wound ranged from 1 to 10 cm. All patients had only acute skin and soft tissue injury, without any fracture, large area skin defect, large area avulsion injury, or chronic diseases such as diabetes mellitus and lower limb vascular disease. The study group contained 37 patients who were treated with local pressure dressing and limb fixation after debridement and suture while the control group included 20 patients who were treated with simple dressing after debridement and suture. At 3, 5, 7, 14, and 21 days after operation, the size of the wound, the type and quantity of exudate, the color of skin around the wound and the type of wound tissue were compared, and the healing time was recorded. Results: All patients were followed up for 30-90 days [(52.2±3.5) days]. Three days after operation, there was no significant difference between the two groups (P>0.05). On the 5th day after operation, the scores of exudate amount, skin color surrounding wound and tissue types of the wound bed in the control group and the study group were (4.2±0.7)points ∶(3.3±0.6)points, (3.5±0.7)points ∶ (2.5±0.6)points, (3.4±0.6)points ∶ (2.5±0.5)points (P<0.05), but there was no significant difference between the two groups in the scores of the size of wound and the type of exudate (P>0.05). On the 7th day after operation, the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (3.5±0.5)points ∶ (2.5±0.7)points, (3.4±0.7)points ∶ (2.4±0.5)points, (4.0±0.8)points ∶ (2.8±0.5)points, (3.4±0.5)points ∶ (1.3±0.5)points, (3.3±0.5)points ∶ (2.1±0.4)points (P<0.05). On the 14th day after operation, the scores of the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (2.9±0.6)points ∶ (1.2±0.7)points, (2.8±0.7)points ∶ 0 point, (3.3±0.7)points ∶ (1.0±0.0)points, (3.1±0.6)points ∶ (1.1±0.4)points, (3.0±0.6)points ∶ (1.2±0.5)points (P<0.05). Twenty-one days after operation, the scores of the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (2.5±0.7)points ∶ 0 point, (2.5±0.5)points ∶ 0 point, (3.0±0.7)points ∶ (1.0±0.0)points, (2.6±0.7)points ∶ (1.1±0.3)points, (2.6±1.1)points ∶ 0 point (P<0.05). The wound healing rate was 100% in both groups. The wound healing time of the control group and the study group was (28.3±6.7)days and (15.2±0.9)days respectively (P<0.05). Conclusion For anterior tibial flask-like wound, local pressure bandaging and fixation after debridement and suture can significantly promote wound healing compared with conventional simple bandaging, with the advantages of better healing quality and shorter healing time.

Objective To investigate the therapeutic effect of damage control neurosurgery (DCNS) on patients with bilateral frontal contusion.Methods Thirty-three patients with bilateral frontal contusion,admitted to and accepted DCNS in our hospital from September 2017 to January 2019,were chosen in our study.According to DCNS rules,the disease condition changes of these patients were monitored,the internal environment disorders after trauma were adjusted,plasma osmotic pressure was increased,and blood oxygen saturation was maintained;once the patients grew worse,craniotomy and decompression should be undertaken immediately;the patients were followed up for 6 months after the injury and Glasgow outcome scale (GOS) was used to determine the prognoses of these patients.Results Among the 33 patients,25 (76％) received conservative treatment successfully,8 (24％) were converted to surgery during conservative treatment.Among the 8 patients,5 received unilateral craniotomy and three received bilateral craniotomy.The lower the Glasgow coma scale scores,the lower the proportion of conservative patients.GOS 6 months after injury showed good recovery in 11 patients,mild disability in 16 patients,severe disability in 4 patients,and plant survival in two patients;22 patients from the conservative treatment group and 5 from the surgery group had good recovery or mild disability.Conclusion DCNS can reduce the operation rate and its complications so as to make the patients recover earlier and better in the treatment of bilateral frontal contusion.

Objective To evaluate the reliability of gas sampling from the distal end of the tracheal tube for partial pressure of end-tidal CO2 (PETCO2) monitoring in neonates.Methods A total of 50 fullterm neonates,scheduled for elective abdominal surgery under general anesthesia,aged 1-28 days,weighing 2.55-4.00 kg,of ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups (n =25 each) using a random number table:gas samples collected from proximal end of tracheal tube group (group P) and gas samples collected from distal end of tracheal tube group (group D).Epidural catheters of 1 mm in external diameter were used.One end of the catheter was connected to a tube for carbon dioxide sampling,and the other end was inserted into the endotracheal tube and advanced toward the distal hole of the tube.At 15 min of mechanical ventilation,blood samples were collected from the radial artery for record of PETCO2 and for blood gas analysis.Consistency test was performed between PETCO2 and partial pressure of arterial CO2 (PaCO2).Results PET CO2 was significantly lower than PaCO2 in the two groups.There was no significant difference in PaCO2between the two groups.PETCO2 was significantly higher in group D than in group P.Kappa was significantly higher in group D than in group P.Conclusion Gas sampling from the distal end of the tracheal tube is more reliable than gas sampling from the proximal end in monitoring PETCO2 in the neonates.

Objective To investigate the effect oflamotrigine (LTG) on repair ofhemisection of spinal cord in mice models.Methods A total of 80 female C57BL/6 mice were employed to establish the models of spinal cord hemisection,and randomly divided into 3 groups:spinal cord injury (SCI) group (n=27),SCI+LTG group (n=26) and SCI+0.9％ saline group (n=26);mice in SCI+LTG group were given intraperitoneal injection oflamotrigine (25 mg/kg) for a consecutive 7 d,and mice in the SCI+0.9％ saline group were given the same volume of 0.9％ saline.Basso,Beatti,Bresnahan (BBB) scale was performed 1,7 and 14 d after SCI;6 mice in each group were sacrificed 1,7 and 14 d after SCI,and glial fiber acidic protein (GFAP) and ionized calcium-binding adaptor molecule 1 (Iba1)-positive cells were observed by immunofluorescence and the expressions of inflammatory factors interleukin (IL)-1,IL-10 and tumor necrosis factor (TNF-α) were observed by ELISA.Results On the 7th and 14th d of injury,the BBB scale scores in the SCI+LTG group were significantly higher than those in the SCI group and SCI+0.9％ saline group (7 d:5.1667±0.40825,4.0000±0.63246 and3.8333±0.40825;14 d:6.5000± 0.5477,5.5000±0.5477 and 5.3333±0.5164,P＜0.05).On the 7th and 14th d of injury,less percentage of GFAP positive ftuorenscent area and fewer number of Iba1 positive cells in the SCI+LTG group were noted than those in the SCI group and SCI+0.9％ saline group (P＜0.05).On the 7th d of SCI,the IL-1 and IL-10 expressions in the SCI+LTG group were obviously lower than those in the SCI group and SCI+ 0.9％ saline group (P＜0.05).Conclusion Lamotrigine improves the motor function after SCI by decreasing the secretion of inflammatory factors and activation of glial cells.