This article explored the treatment of laryngopharyngeal reflux disease （LPRD） from the perspective of ascending and descending of qi. It is believed that the disorder of qi movement of the middle jiao （焦） is the key to the pathogenesis of LPRD. The ascending and descending disorder of liver and lung is an important factor in its prolongation and progression. The treatment of LPRD should follow the nature of the spleen and stomach， with the focus on fortifying and transporting the spleen and the stomach， supplemented by soothing the liver and diffusing the lung. The herbs such as Cangzhu （Rhizoma Atractylodis）， Fuling （Poria）， Yiyiren （Semen Coicis）， Gegen （Radix Puerariae Lobatae） and Shanyao （Rhizoma Dioscoreae） could be used for fortifying and circuiting the center earth， and Chaihu （Radix Bupleuri）， Muxiang （Radix Aucklandiae）， Zhiqiao （Fructus Aurantii） and Baishao （Radix Paeoniae Alba） for soothing the liver and nourishing the blood to harmonize the ascending and descending. Jiegeng （Radix Platycodonis） and Xuanfuhua （Japanese Inula Flower） are supplemented to diffuse and direct lung qi downward thereby mediating the center jiao. In this way， the qi movement of the spleen and stomach is restored， and the ascending and descending between the liver and lung are harmonized， and therefore the disease is cureda.

Objective:To explore the material basis and potential mechanism of Sanhuang Yishen Capsules in the treatment of diabetes through network pharmacology, molecular docking and experimental verification.Methods:The active components and targets of Sanhuang Yishhen Capsules were screened using China Natural product chemical composition database and SymMap database, and the related targets of T2DM were screened by GeneCards database. The "Chinese materia medica-active component-target" network was constructed, and the intersection genes were enriched by GO and KEGG using R language. Key active components were selected for molecular docking verification with potential core targets. 60 rats were divided into normal group, model group, and Sanhuang Yishen Capsules group according to random number table method, with 15 rats in each group. In addition to the normal group, the diabetic rat model was prepared in the other groups, and the corresponding drugs were intragastric in each group for 8 weeks. The levels of fasting blood glucose (FBG), fasting insulin (FINS) and insulin resistance index (HOMA-IR) were measured by radioimmunoassay. Western blotting was used to detect protein expressions of epidermal growth factor receptor (EGFR), epidermal growth factor (EGF), Akt serine/threonine kinase 1 (AKT1), recombinant tumor protein p53 (TP53), and recombinant caspase 3 (CASP3).Results:A total of 160 active components and 298 targets of Sanhuang Yishen Capsules, 2194 targets related to T2DM, and 166 intersection targets were obtained. GO and KEGG analyzed a series of biological reaction processes mainly involved in signal transduction, oxidative stress, apoptosis, etc., and mainly involved in the regulation of P13K/Akt, P53, CASP3 and other targets. The results of molecular docking showed that the main active components obtained by screening had strong binding with the target. Compared with model group, FBG, FINS, HOMA-IR, TP53 and CASP3 in Sanhuang Yishen Capsules group decreased ( P<0.05), EGFR, EGF and Akt1 proteins increased ( P<0.05). Conclusion:The mechanism of Sanhuang Yishen Capsules for the treatment of may be related to the regulation of EGF/EGFR/P13K/Akt signaling pathway, TP53 signaling pathway, CASP3 signaling pathway, PPARG signaling pathway, ESR1 signaling pathway, PTGS2 signaling pathway, CAT signaling pathway and CTNNB1 signaling pathway.

In order to preliminarily evaluate the efficacy and safety of endoscopic intermuscular dissection (EID) for the treatment of rectal neuroendocrine tumors (R-NETs), a retrospective observational study was conducted on 8 consecutive patients with R-NETs confirmed by postoperative pathology at South China Hospital, Medical School, Shenzhen University from January 2022 to October 2023. The therapeutic efficacy, incidence of complications, and follow-up results were mainly analyzed. The results showed that all 8 cases achieved complete resection after EID, with operation times ranging from 40 to 90 minutes. No bleeding, perforation, fever or electrocoagulation syndrome occurred after operation. The hospital stay was 4 to 6 days. During follow-up of 3 to 24 months, there was no local recurrence or metastasis. Therefore, a preliminary conclusion can be drawn that EID is a safe and feasible treatment for R-NETs.

Objective:To study the function and possible mechanism of Fufang-Zhongjiefeng aerosol in the treatment of chronic pharyngitis. Method:Sixty SD rats were randomly divided into normal group, model group, low-, medium-, and high-dose Fufang-Zhongjiefeng aerosol group, and positive drug group, with 10 rats in each group. Except the normal group, the pharynx of other groups were injected with group A beta-hemolytic streptococcus (GAS) to establish chronic pharyngitis rat model. After the modeling, the low-, medium-, and high-dose Fufang-Zhongjiefeng aerosol groups were sonicated with 20 ml of 0.9% normal saline to dissolve the Fufang-Zhongjiefeng aerosol 2.33, 4.66, 9.32 g/kg, respectively. The normal group and the model group were given the same volume of normal saline, and the positive drug group was intraperitoneally injected with ampicillin sodium 0.93 g/kg once a day for 14 days. The pathological changes of pharyngeal mucosa were detected by hematoxylin and eosin (HE) staining. The levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and nterleukin-6 (IL-6) in serum were detected by Enzyme-linked Immunosorbent Assay (ELISA). The expression levels of toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88) and nuclear factor kappa B (NF-κB) p65 protein in pharyngeal mucosa were detected by immunohistochemistry. The expression levels of TLR4, MyD88 and NF-κB p65 mRNA in pharyngeal mucosa were detected by quantitative real-time reverse transcription-polymerase chain reaction (RT-qPCR). Results:Compared with the model group, the serum TNF-α, IL-1β and IL-6 levels of rats in the Fufang-Zhongjiefeng aerosol low-, medium-, high-dose group and the positive drug group were significantly reduced ( P<0.05). The expression of TLR-4, MyD88 and NF-κB p65 protein in the pharyngeal mucosal tissue of rats in the low-, medium-, high-dose Fufang-Zhongjiefeng aerosol group and the positive drug group were significantly reduced ( P<0.05). The expressions of TLR-4 mRNA (1.17 ± 0.41, 2.44 ± 1.06, 1.25 ± 0.34 vs. 3.87 ± 1.43), MyD88 mRNA (1.15 ± 0.53, 1.75 ± 0.36, 1.09 ± 0.14 vs. 2.44 ± 0.19), and NF-κB p65 mRNA (1.97 ± 0.51, 2.64 ± 0.26, 2.31 ± 0.44 vs. 5.08 ± 0.34) in the pharyngeal mucosa tissue of rats in the medium-, high-dose group and the positive drug group were significantly reduced ( P<0.05). Conclusion:Fufang-Zhongjiefeng aerosol can effectively treat chronic pharyngitis, which could inhibit the expression of TLR-4, MyD88, and NF-κB to reduce the expression of inflammatory factors so as to play the rold of anti-inflammatory effect.

Objective:To investigate the effect of 24-hour continuous feeding by pump on gastrointestinal dysfunction and early growth of very low birth weight infants (VLBWI).Methods:Eighty VLBWI fed by tube in the Neonatal Intensive Care Unit (NICU) of Fuyang Women and Children′s Hospital, Anhui Province from January 2017 to June 2019, were retrospectively analyzed.They were randomly divided into the observation group and the control group according to the simple randomization method, 40 cases in each group.The observation group included 23 males and 17 females, with the gestational age of 28 + 2-33 + 5 weeks, and birth weight of 1.04-1.47 kg.The control group included 21 males and 19 females, with the gestational age of 28 + 1-33 + 5 weeks, and birth weight of 1.05 -1.47 kg.On the basis of giving both groups routine treatment, nursing, and non-nutritional sucking, the control group was treated with intermittent tube feeding and infusion of formula milk, while the observation group was microfed 24 h continuously by pump.The general situation, meconium discharge time, frequency of daily defecation, daily milk volume, gastrointestinal dysfunction, increase of body weight after birth, and neonatal behavioral neurological assessment (NBNA) at 40 weeks of gestational age were compared between the two groups.The increase of body mass after birth and the determination of neonatal behavioral neurological assessment (NBNA) in neonatal behavioral nerve at 40 weeks of gestational age were statistically analyzed by χ2 test and t test. Results:(1)There were no significant differences in sex, gestational age, birth weight, head circumference and body length between the 2 groups (all P>0.05). (2) Compared with the control group, the premature infants in the observation group had increased daily milk volume [(12.95±2.34) g/d vs.(10.08±2.08) g/d], shortened meconium discharge time [(3.90±0.84) d vs.(5.02±0.86) d], and higher frequency of daily defecation[(3.85±1.07) times/d vs.(3.00±0.81) times/d], shortened extubation time[(14.75±3.20) d vs.(16.80±3.08) d], shortened time of weight to loss to minimum[(3.38±0.86) d vs.(4.22±0.89) d], faster growth of the daily average body weight[(15.25±2.29) g/(kg·d) vs.(11.55±1.56) g/(kg·d)], shortened average hospitalization time [(35.58±8.29) d vs.(39.42±8.29) d], and faster increase of the head circumference[(35.23±2.40) cm vs.(33.74±1.63) cm]. The differences were statistically significant ( t=5.805, -5.907, 3.981, -2.918, -2.825, 3.890, -2.060, 3.233, all P<0.05). (3)The incidence of vomiting, abdominal distension, hypoglycemia and hyperbilirubinemia in the observation group was significantly lower than that in the control group ( χ2=5.000, 16.050, 5.165, 14.528, all P<0.05). (4) There was no significant difference in necrotizing enterocolitis (NEC) and dyspnea between the two groups ( χ2=1.438, 10.251, all P>0.05). The total scores of behavioral ability, passive muscle tension, active muscle tension, primitive reflex, general evaluation and NBNA in the observation group were higher than those in the control group, the difference was statistically significant ( t=5.026, 3.207, 3.000, 2.421, 3.150, 6.141, all P<0.05). Conclusions:Twenty-four-hour continuous feeding by pump combined with non-nutritious sucking can significantly reduce the occurrence of gastrointestinal dysfunction in VLBWI, promote the development and maturation of gastrointestinal function, improve the nutritional status, accelerate the physical growth, and thus facilitate the development of behavioral nerve.

Objective To compare the dosimetric difference among TomoDirect (TD) radiotherapy,Helical Tomotherapy(HT) and volumetric modulated arc therapy(VMAT) in the treatment of upper thoracic esophageal carcinoma.Methods A total of 15 patients with cT2-4 N0-1 M0 upper thoracic esophageal squamous cell carcinoma were enrolled.Three plans were generated using the same dose objective for each patient:TD,HT and VMAT.Dose-volume histogram (DVH),homogeneity index (HI),conformal index (CI),dose at organ at risk (OAR),delivery time and monitor unit (MU) were compared among different plans.Results The D2 and D values in the HT and TD plans were significantly lower than those in the VMAT plans.The D98 value in the TD was similar to that in the HT,but lower than that in the VMAT.The HI of HT was significantly better than those of TD and VMAT (F =81.603,P ＜ 0.05).For the CI,there was no significant difference among the three techniques (P ＞ 0.05).For the V15 of lung,HT was significantly higher than TD (t =-2.626,P ＜0.05) and VMAT (t=3.547,P ＜ 0.05).The V20 of lung in TD was similar to that in HT,but higher than that in VMAT (t =2.824,3.052,P ＜ 0.05).The Dmax of spinal cord showed no significant difference among the three techniques.VMAT had a significantly shorter delivery time and lower MU compared with HT and TD (t =21.617,15.693,10.018,7.802,P ＜ 0.05).Conclusions HT and TD could gain a better planning target volume (PTV) coverage and HI than VMAT in the treatment of upper thoracic esophageal carcinoma.However,VMAT achieved the lowest lung V20,the least Mus and the shortest delivery time.HT achieved a better PTV coverage compared with TD,but TD had a lower lung V15 Mus and shorter delivery time compared with HT.

BACKGROUND:The establishment of a safe, reliable and easily repeatable mouse model of nonalcoholic fatty liver disease is the prerequisite for the study of the diagnosis and treatment of the disease.
OBJECTIVE:To establish a C57BL/6 mouse model of nonalcoholic fatty liver disease and observe changes of biochemical indicators, which can provide a theoretical basis for its pathogenesis and drug treatment.
METHODS:Sixty healthy male C57BL/6 mice were randomly divided into a control group of 30 cases (normal diet), and a model group of 30 cases (high fat diet). Models of nonalcoholic fatty liver were established. At 8 weeks, body mass, liver index, and homogenate superoxide dismutase activity in the liver were detected. Changes in serum alanine aminotransferase, aspartate aminotransferase, triglyceride glycerol, cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were observed. Pathological examination was performed.
RESULTS AND CONCLUSION:(1) Pathological sections showed that large droplets and smal lipid droplets in the mouse liver and spread the whole liver. Swel ing of the liver cel s, visible cytoplasmic vacuoles and obviously inflammatory changes in liver cel s were observed in the model group. (2) Body weight and liver index were significantly higher in the model group than in the control group (P<0.05). Superoxide dismutase activity was significantly reduced in the liver (P<0.05). (3) Triglycerides, cholesterol, and low-density lipoprotein cholesterol levels were significantly higher, but high-density lipoprotein cholesterol levels were significantly lower in the model group than in the control group (P<0.05). (4) Nonalcoholic fatty liver mouse model is ideal for high-fat diet-induced animal model. The method is simple, repetitive, and can provide a stable animal model for the study on the mechanism of nonalcoholic fatty liver disease and drug treatment.

Objective To study the effect of three dimensional conformal intensity modulated radiotherapy and prognostic factors for postoperative local recurrent esophageal squamous cell carcinomas.Methods A total of 468 patieuts with postoperative local recurrent esophageal squamous cell carcinomas were retrospectively analyzed.The median interval between surgery and recurrence was 14.95 months (2-252 months).There were 45 patients with supraclavicular lympy node relapse,291 with mediastinal lymph node relapse,4 with abdominal lymph node relapse,15 with anastomosis relapse,89 with supraclavicular and mediastinal lymph node relapse,11 with anastomosis and mediastinal lymph node relapse,7 with mediastinal and abdominal lymph node relapse,1 with supraclavicular and anastomosis relapse,2 with supraclavicular and abdominal lymph node relapse,3 with anastomosis,mediastinal and supraclavicular lymph node relapse.There were 224 patients who received three-dimensional conformal radiation therapy,and the other 244 patients of intensity-modulated radiation therapy,with a median dose of 59.4 Gy (40-70 Gy).A total of 166 patients received adjuvant chemotherapy.Kaplan-Meier method was used to calculate the survival rate;Log-rank test was used for univariate prognostic analysis;Cox regression test was used for multivariate prognostic analysis.Results The follow-up rate was 95.3％.The recent curative effect in the effective rate was 81.6％,with 41.2％ CR rate.The overall 1,2,3,4 years of survival rates after radiotherapy were 61％,32％,21％,14％ respectively and the median survival time was 17.6 months.Univariate analysis showed that age,.pathologic stage,the number of positive lymph node cleaning,the recurrence area,single or multiple lesions,the size of the lesion,overall response rate,radiation dose,and chemotherapy (x2 =4.814-247.322,P ＜ 0.05) were associated with prognosis.Multivariate analysis showed that age,pathologic stage,the recurrence area,single or multiple lesions,the size of the lesion,overall response rate,radiation dose,and chemotherapy (P ＜0.05) were independent prognostic factors.A total of 370 patients had progressive diseases after radiotherapy,176 had local failure 47.57％ (176/370),148 had distant metastasis 40.00％ (148/370) and 16 had both local and distant failures 4.32％ (16/370).One case died of pneumonia;2 cases died of acute myocardial infarction;1 case died of cerebral hemorrhage;26 cases died of unknown cause (including lost to follow-up).Lung was the most common distant metastatic site.Conclusions Radiotherapy may improve the survival of esophageal squamous cell carcinoma patients with postoperative recurrence.Patients with less than 70 years old,early postoperative stage,single recurrent lesion,initial small lesions,response to radiotherapy,radiation dose of higher than 59.4 Gy,chemoradiation might have better prognosis.

Objective To explore the surgical technique and clinical effect of combined great toe wraparound flap and second toe tissue flap transfer for subemergency reconstruction of grade Ⅲ and Ⅳ thumb defect.Methods From July,2011 to March,2014,12 patients of grade Ⅲ and Ⅳ thumb defect were treated by transfering combined great toe wrap-around flap and second toe tissue flap transfer.The second toe tissue flap was carried out to cover donor site defect of the big toe.Results All the 12 transplants survied and were followed up for 6 to 24 months.The reconstructed thumbs had near nomal appearace and good fuction,2-point discrimination ranged from 0.6 cm to 0.8 cm.According to the trial standard of upper limb part of functional assessment of the Hand Surgery Branch of Chinese Medical Association,among the 12 eases,there were excellent in 9,good in 3.Impact on the donor foot was minor with limited complications.The patients were able to weight-bearing walking after one months of operation.For long-term follow-up,no case had successive ulces,obvious pain and claudication.Conclusion The reconstructed thumbs by great toe wrap-around flap combined with the tissue flap of second toe had near nomal appearace and good fuction.

OBJECTIVETo evaluate the application of inferior vena cava filter (IVCF) in prevention of peri-operative pulmonary embolism (PE) in lower limb bone fracture patients with deep venous thrombosis (DVT).

METHODSFrom January 2003 to December 2012, 2 248 cases of lower limb and pelvic fractures with DVT were retrospectively analyzed. Before the procedure of IVCF implantation began, January 2003 to December 2007, there were 1 052 cases of acute trauma patients with DVT were classified as the group of early none-IVCF. The IVCF implantation was began since January 2008. From that time to December 2012, 712 cases of bone fractures with DVT received filter implantation, which were classified as IVCF group. The other 484 patients who had not undergone filter deployment were divided as group of late none-IVCF. The baseline conditions of the three groups were significantly different in addition to the ages between group of early none-IVCF and IVCF group. The incidences of PE and mortality of PE in each group were recorded and analyzed by χ(2) test.

RESULTSThere were totally 31 cases of symptomatic PE, among which 12 cases died. Totally 712 filters were deployed successfully without any major complications. The incidences of symptomatic PE were 0.14% (1/712), 2.19% (23/1 052) and 1.45% (7/484) in IVCF group, group of early none-IVCF and group of late none-IVCF, respectively. The mortality of PE were 0 (0/712), 0.86% (9/1 052) and 0.62% (3/484) in these groups. The incidence of symptomatic PE in IVCF group was significantly different from that in the group of early and late none-IVCF (χ(2) = 11.762, P = 0.001; χ(2) = 7.395, P = 0.007, respectively). The mortality of IVCF group was also significantly lower compared with the other two groups (χ(2) = 6.122, P = 0.013; χ(2) = 4.424, P = 0.035, respectively).

CONCLUSIONIVCF implantation effectively prevents symptomatic and fatal PE of patients of lower limb and pelvic fractures with DVT in the peri-operative period.

Adult ; Aged ; Female ; Humans ; Leg Injuries ; complications ; Lower Extremity ; Male ; Middle Aged ; Pulmonary Embolism ; etiology ; prevention & control ; Retrospective Studies ; Vena Cava Filters ; Venous Thrombosis ; complications