This study aims to explore the mechanism of Qingkailing(QKL) Oral Preparation's heat-clearing, detoxifying, mind-tranquilizing effects based on "component-target-efficacy" network. To be specific, the potential targets of the 23 major components in QKL Oral Preparation were predicted by the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP) and SwissTargetPrediction. The target genes were obtained based on UniProt. OmicsBean and STRING 10 were used for Gene Ontology(GO) term enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment of the targets. Cytoscape 3.8.2 was employed for visualization and construction of "component-target-pathway-pharmacological effect-efficacy" network, followed by molecular docking between the 23 main active components and 15 key targets. Finally, the lipopolysaccharide(LPS)-induced RAW264.7 cells were adopted to verify the anti-inflammatory effect of six monomer components in QKL Oral Preparation. It was found that the 23 compounds affected 33 key signaling pathways through 236 related targets, such as arachidonic acid metabolism, tumor necrosis factor α(TNF-α) signaling pathway, inflammatory mediator regulation of TRP channels, cAMP signaling pathway, cGMP-PKG signaling pathway, Th17 cell differentiation, interleukin-17(IL-17) signaling pathway, neuroactive ligand-receptor intera-ction, calcium signaling pathway, and GABAergic synapse. They were involved in the anti-inflammation, immune regulation, antipyretic effect, and anti-convulsion of the prescription. The "component-target-pathway-pharmacological effect-efficacy" network of QKL Oral Preparation was constructed. Molecular docking showed that the main active components had high binding affinity to the key targets. In vitro cell experiment indicated that the six components in the prescription(hyodeoxycholic acid, baicalin, chlorogenic acid, isochlorogenic acid C, epigoitrin, geniposide) can reduce the expression of nitric oxide(NO), TNF-α, and interleukin-6(IL-6) in cell supernatant(P<0.05). Thus, the above six components may be the key pharmacodynamic substances of QKL Oral Preparation. The major components in QKL Oral Prescription, including hyodeoxycholic acid, baicalin, chlorogenic acid, isochlorogenic acid C, epigoitrin, geniposide, cholic acid, isochlorogenic acid A, and γ-aminobutyric acid, may interfere with multiple biological processes related to inflammation, immune regulation, fever, and convulsion by acting on the key protein targets such as IL-6, TNF, prostaglandin-endoperoxide synthase 2(PTGS2), arachidonate 5-lipoxygenase(ALOX5), vascular cell adhesion molecule 1(VCAM1), nitric oxide synthase 2(NOS2), prostaglandin E2 receptor EP2 subtype(PTGER2), gamma-aminobutyric acid receptor subunit alpha(GABRA), gamma-aminobutyric acid type B receptor subunit 1(GABBR1), and 4-aminobutyrate aminotransferase(ABAT). This study reveals the effective components and mechanism of QKL Oral Prescription.
Chlorogenic Acid ; Drugs, Chinese Herbal/pharmacology* ; gamma-Aminobutyric Acid ; Interleukin-6 ; Medicine, Chinese Traditional ; Molecular Docking Simulation ; Tumor Necrosis Factor-alpha/genetics* ; Animals ; Mice ; RAW 264.7 Cells

Objective:To introduce a new TIANJI robot assisted targeted puncture technique, and discuss the feasibility and clinical effect of transforaminal percutaneous endoscopic lumbar discectomy (tPELD) using this technique.Methods:The first 14 consecutive cases of single level lumbar disc herniation who underwent robot assisted tPELD procedure were retrospectively analyzed. The mean age was 46.3±16.0 years old (ranged from 16-72). After data transferred from C-arm to robot system and automatic registration, surgeons made plans of the trajectory on robot system based on intraoperative 3-dimensional images of lumbar spine. Move robotic arm to planned position, guide an accurate puncture pathway and establish working cannula. 25 consecutive patients who underwent conventional C-arm assisted tPELD surgery during the same period of time were assessed as the controlled group. The mean age was 45.5±13.7 years old (ranged from 16-68). All patients were followed up for 12 months. Clinical effect was assessed by visual analogue scale (VAS), Oswestry disability index (ODI) and Modified Macnab criteria. Intraoperative parameters and surgery-related complications were recorded.Results:The baseline data of age, surgical level, types of herniation, preoperative VAS scores and ODI had no significant difference between two groups ( P>0.05). In robot group, one case was converted to open microdiscectomy during operation due to technical failure. The other thirteen cases had successful robot assisted tPELD surgeries and were assessed accordingly. The new technique had good clinical outcomes. The immediate post-operative VAS score 2.85±1.79 and the last follow-up VAS score 1.50±1.04 were both significantly decreased than that before surgery 7.62±0.92 ( F=69.747, P<0.01); the last follow-up ODI 18.89%±12.16% was significantly reduced from the pre-operative ODI 71.19%±12.12% ( t=15.430, P<0.01). Between two groups, the immediate post-operative VAS score ( t=0.568, P=0.574), the last follow-up VAS score ( t=0.713, P=0.481), and last follow-up ODI had no significant difference ( t=0.171, P=0.865). The excellent or good rate of modified Macnab criteria at the last follow-up was 92.30% in robot group, comparing to 84.0% in controlled group. The fluoroscopic times during surgery of robot group 8.8±5.5 was significantly lowered the in controlled group 21.3±8.3 ( P<0.01). One case in robot group and two cases in controlled group had recurrence during follow-up period (recurrence rate 7.7% vs. 8.3%). However, there was no significant complications such as nerve root injury, dura injury or increased intracranial pressure in both groups. Conclusion:This study confirmed the feasibility of this new technique. Preliminary results indicated that TIANJI robot could help to build an easy, accurate and safe procedure of tPELD surgery.

Objective:To explore the effect of empowerment education in patients with coronary heart disease after percutaneous coronary intervention (PCI) .Methods:From June 2020 to July 2021, convenience sampling was used to select 90 patients with coronary heart disease who received PCI in the Department of Cardiology of Qinhuai Medical District, Eastern Theater Command General Hospital as the research object. The 45 patients admitted from June to December 2020 were set as the control group, and the 45 patients admitted from January to July 2021 were set as the observation group. The control group received routine health education, and the observation group was given empowerment education on this basis. The physical activity level and aerobic exercise endurance of the two groups of patients were compared.Results:Repeated measures analysis of variance showed that there were between-group, time and interaction effects in the 6-minute walking distance between the two groups before intervention, one month and three months after intervention, and the differences were statistically significant ( P<0.05) . The physical activity levels of patients in the observation group were higher than those in the control group after one and three months of intervention, and the differences were statistically significant ( P<0.05) . Conclusions:Empowerment education can improve physical activity level and aerobic exercise endurance in patients with coronary heart disease after PCI.

Spinal surgery is a technically demanding and challenging procedure because of the complicated anatomical structures of the spine and its proximity to several important tissues. Surgical landmarks and fluoroscopy have been used for pedicle screw insertion but are found to produce inaccuracies in placement. Improving the safety and accuracy of spinal surgery has increasingly become a clinical concern. Computerassisted navigation is an extension and application of precision medicine in orthopaedic surgery and has significantly improved the accuracy of spinal surgery. However, no clinical guidelines have been published for this relatively new and fast-growing technique, thus potentially limiting its adoption. In accordance with the consensus of consultant specialists, literature reviews, and our local experience, these guidelines include the basic concepts of the navigation system, workflow of navigation-assisted spinal surgery, some common pitfalls, and recommended solutions. This work helps to standardize navigation-assisted spinal surgery, improve its clinical efficiency and precision, and shorten the clinical learning curve.

Objective:To analyze the EGFR gene polymorphism in the non-small cell lung (NSCLCs) cancer in southern of Shaanxi Province.Methods:The next generation sequencing technology was used to detect the mutation of exon 18,19,20 and 21 of EGFR gene.We analyzed EGFR gene mutation rate in NSCLCs patients.233 patients was involved in our study.Results:82 cases with EGFR gene mutations was found,the mutation rate of exon18,19,20 and 21 was 1.3％,16.3％,0％ and 18％ respectively.The mutation rate of EGFR in male patients was lower (31.2％,39/125) than that of female cases (39.8％,43/108),the mutation rate of squamous cell carcinoma (22％,9/41) was lower than that of adenocarcinoma (39.1％,75/192).Conclusions:NSCLCs patients from southern Shaanxi Province had high mutation rate ofEGFR gene,and exon 19 and exon 21 mutations were in the majority.EGFR gene mutation rate was not related to gender and pathological types.

Objective:To present our experience of the surgical treatment of maxillofacial fibrous dysplasia(FD) using surgical navigation technology.Methods:14 patients with maxillofacial FD were included.Preoperative CT scanning data were obtained and a virtual plan based on the patient's mirrored anatomy was realized.Intraoperatively,a digital reference frame was fixed rigidly to patient's forehead or mandible depending on the location of the lesion.During operation each patient and the virtual image were matched through individual registration technique.A pointing device was constantly used to determine whether the extent of resection was consistent with the preoperative design.The surgical outcome was assessed through fusion of the preoperative planning and postoperative CT reconstruction image.Results:The application of surgical navigation system enhanced the safety and the accuracy of the surgery for the resection of the focal lesion and for the recontour of the profile.There was no complications during 1-3 years follow up.Conclusion:Surgical navigation based on a virtual plan proves to be safe and accurate,and is of great value in managing maxillofacial fibrous dysplasia.

Objective To understand the status of implementation of invasive ventilator circuit changes in ICU nurses at the 3A general hospitals in Shanxi Province, and mastering and demand of related knowledge of ICU nurses, and by this discuss the possible causes of execution inconsistency in invasive ventilator circuit changes interval so as to provide a clear basis for the specification and circuit changes. Methods After a review of relevant literature at home and abroad as well as expert consultation, a self-designed questionnaire was established, take two ways of on-site issuance and mailing, ICU nurses from 13 hospitals were selected randomly to investigate about the invasive circuit changes interval in Shanxi Province. Results A total of 724 nurses from 34 ICU of 13 hospitals were surveyed. A unified circuit changes interval of ICU accounted for 73.5% (527/717). ICU nurses currently provisions and practical implementation of invasive ventilator circuit changes interval tend to 7 d. Different ICU provisions and ICU nurses actual implementation of circuit change were significantly different (χ2=24.839, 35.760, P < 0.01). Conclusions Hospitals should choose the right way to strengthen the ICU nurses invasive ventilator circuit changes training interval and knowledge, to develop the term for their own security environment, thereby reduce the workload of nurses, reduce medical costs and improve care service quality.

Objective To evaluate the changes of left ventricular (LV) bulk rotation and untwisting in transplanted hearts using 2-dimensional speckle tracking imaging(STI).Methods Basal and apical LV short-axis images were acquired in 15 heart transplant recipients 3 months post surgery(HT group) and 56 healthy control subjects.Basal and apical rotation versus time profiles were drawn using 2-dimensional STI software.Appropriate values were chosen from the dataset obtained and compared between two groups.Results ①Compared with the control group,the heart rate,anterior-posterior diameter of left atrium,enddiastolic interventricular septum thickness,left ventricular posterior wall thickness,isovolumic relaxation time and E/e ratio were significantly increased,e and a values were decreased significantly in HT group (P ＜ 0.05).② No significant difference was noticed in the peak degrees of LV bulk rotation,the degrees of LV bulk rotation at the time of aortic valve closure and mitral valve opening (P =0.700,0.984,0.495,respectively) between 2 groups.In both groups,systolic rotation reached its maximum at end-systole [(96.1 ± 8.4) ％ in HT group vs (100.5 ± 6.3) ％ in control group,P =0.065].③Significant decreases in untwisting rate and trend untwisting variables were observed in the HT group(P ＜0.001).Conclusions 3 months after transplanted,left ventricular bulk rotation of cardiac allografts remained normal,and significant decreases in both untwisting rate and trend untwisting variables showed that the diastolic function of cardiac allografts was impaired.

In order to investigate the anti-tumor angiogenesis activity with a recombinant Ag43/FGFR1 chimeric protein(AF)vaccine in a mouse H22 hepatoma model,tumor volume and survival rate of the mice were studied at a 3-day interval,Microvessel density(MVD)was detected by immunohistochemistry.The endothelial deposition of autoantibodies within tumor tissues was examined by immunofluorescent staining,and anti-FGFR1 antibody-producing B cells(APBCs)were tested by enzyme-linked immunospot(ELISPOT)assay.Compared with the three control groups,the tumor volume was significantly decreased and the survival time was significantly prolonged in AF-immunized group(P<0.05).The number of APBCs in AF-immunized mice(129.6±10.9)was more than in controls[6.2±1.1(FGFR1),6.0±1.2(Ag43)and 5.2±1.4(NS),P<0.01].Moreover,the endothelial deposition of autoantibodies was found in tumor tissues from AF-immunized mice,but not in control groups.MVD in AF-immunized group was significantly lower than in FGFR1-immunized group,Ag43-immunized group and NS group(10.3±3.1 vs 39.4±8.6 vs 42.3±9.8 and 43.6±10.6,P<0.01).These findings demonstrated that the AF protein vaccine effectively inhibited tumor angiogenesis and growth via production of autoantibodies against self-FGFR1.

Objective To assess right ventricular(RV) global longitudinal function in patients with pulmonary arterial hypertension (PAH) by 2-dimensional ultrasound speckle tracking imaging (STI). Methods According to pulmonary artery systolic pressure, 42 patients with PAH were divided into mild (17) ,moderate(15) and severe(10) PAH groups. RV global longitudinal peak systolic strain (GLS), strain rate(GLSRs) ,early diastolic strain rate (GLSRe) and late diastolic strain rate (GLSRa) were measured in 42 patients with PAH and 31 healthy controls by STI from the apical 4-chamber view and compared between groups and assessed the determinants of the RV global longitudinal functional parameters. Results Right ventricular GLS,GLSRs,GLSRe, GLSRa were significantly impaired in patients with PAH compared with controls (P<0.05 for all). Right ventricular GLS were most altered in patients with the severe PAH group compared with mild PAH patients (P<0. 05). Right ventricular GLSRs, GLSRe, GLSRa were not significant between mild,moderate and severe PAH groups(P>0.05). Pulmonary vascular resistance and pulmonary artery systolic pressure were the determinants of RV global longitudinal systolic function(r= - 0.466～- 0. 549, r = - 0. 403～- 0. 425, respectively, P <0.05 for both). There were good correlations between tricuspid annular systolic peak velocity and RV GLS,GLSRs in patients with PAH (r = 0. 556～0. 585, P < 0.001). Conclusions RV global function decreases in patients with PAH, RV global longitudinal function can be accurately and objectively studied by STI.