Stroke is the main cause of death and disability among adults in China and is characterized by high incidence， disability， mortality， and recurrence rates. The combination of traditional Chinese and Western medicine has great potential in treating stroke and its sequelae. The classic traditional Chinese medicine prescription Da Chengqitang （DCQT） has a long history and proven efficacy in treating stroke. Clinically， DCQT is often used to treat stroke and its sequelae. However， the number and quality of clinical trials of DCQT in treating stroke need to be improved. Because of the insufficient basic research， the active ingredients and multi-target mechanism of action of DCQT remain unclear. Our research group has previously confirmed that DCQT can effectively reverse neurological damage， reduce iron deposition， and downregulate the levels of pro-inflammatory cytokines in the rat model of hemorrhagic stroke. The treatment mechanism is related to the nuclear factor erythroid 2-related factor 2 （Nrf2）-mediated signaling pathway and p38 mitogen-activated protein kinase （MAPK） signaling-mediated microglia activation. To clarify the pharmacodynamic basis and anti-stroke mechanism of DCQT， this article reviews the research progress in the treatment of stroke with DCQT in terms of clinical trials， pharmacodynamic material basis， safety evaluation， and mechanisms of absorbed components. This article summarizes 45 major phytochemical components of DCQT， 11 of which are currently confirmed absorbed components. Among them， emodin， rhein， chrysophanol， aloe-emodin， synephrine， hesperidin， naringin， magnolol， and honokiol can be used as quality markers （Q-markers） of DCQT. The mechanism of DCQT in treating stroke is complex， involving regulation of inflammatory responses， neuronal damage， oxidative stress， blood-brain barrier， brain-derived neurotrophic factor， and anti-platelet aggregation. This article helps to deeply understand the pharmacodynamic basis and mechanism of DCQT in treating stroke and provides a theoretical basis for the clinical application of DCQT in treating stroke and the development of stroke drugs.

BACKGROUND:A large number of studies have confirmed that tissue engineering scaffolds can almost completely repair osteochondral defects.However,when osteochondral defects are complicated with infection,even after thorough debridement in the early stage,the repair effect of simple osteochondral tissue engineering scaffolds is often unsatisfactory. OBJECTIVE:To prepare fibroin/chitosan/nano-hydroxyapatite scaffold loaded with vancomycin hydrochloride sustained release microspheres,and to investigate the repair effect on infected osteochondral defect in distal femur of rabbit. METHODS:(1)Vancomycin hydrochloride sustained release microspheres were prepared by emulsified solvent evaporation method.The sustained-release microspheres of different weights(7.5,10,and 12.5 mg)were mixed with fibroin protein-chitosan nanohydroxyapatite solution,and the scaffolds of fibroin protein/chitosan/nano-hydroxyapatite were prepared by chemical crosslinking method.The porosity,water absorption and expansion rate,hot water loss rate of the scaffolds,and drug sustained-release in vitro were characterized.(2)Forty-five New Zealand white rabbits were randomly divided into blank group,control group,and experimental group,with 15 rabbits in each group.The osteochondral defect and infection model of the distal femur of the right hind limb was established in both groups.The blank group was not treated,and the control group was implanted with fibroin protein-chitosan-nano-hydroxyapatite scaffold.Vancomycin hydrochloride sustained-release microspheres(10 mg)of fibroin/chitosan/nano-hydroxyapatite scaffold were implanted in the defect of the experimental group.The levels of C-reactive protein and leukocytes in blood samples were detected 1 week after operation.At 4,8 and 12 weeks after operation,the tissue of the operative area was taken for gross observation and pathological observation. RESULTS AND CONCLUSION:(1)With the increase of sustained-release microspheres content,the porosity of scaffolds decreased,and there was significant difference among groups(P＜0.05).There were no significant differences in the pore size,water absorption expansion rate and hot water loss rate among the three groups(P＞0.05).Vancomycin hydrochloride was released sustainably in vitro for more than 30 days in all three groups of scaffolds.(2)The levels of C-reactive protein and leukocytes in blood samples of the experimental group were lower than those of the blank group and control group(P＜0.05).The repair of gross cartilage in the experimental group was significantly better than that in the blank group and the control group.Hematoxylin-eosin,Masson,Alcian blue and type Ⅱ collagen immunohistochemical stainings showed that the osteochondral repair effect of the experimental group was significantly better than that of the blank group and the control group at each time point.(3)The results showed that fibroin/chitosan/nano-hydroxyapatite scaffolds loaded with vancomycin hydrochloride sustained-release microspheres could effectively promote the repair of open osteochondral defects.

Objective:To analyze the clinical efficacy of different intervention regimens combined with Sintilimab and Lenvatinib in the treatment of liver cancer.Methods:Using a case-control study method, a retrospective analysis was conducted on 72 patients with advanced liver cancer admitted to Huangshi Central Hospital from January 2020 to January 2023. They were divided into two groups according to the treatment plan. The TACE group (36 cases) received transcatheter hepatic artery embolization chemotherapy (TACE)+ Sintilimab+ Lenvatinib, while the HAIC group (36 cases) received hepatic artery infusion chemotherapy (HAIC)+ Sintilimab+ Lenvatinib. The research data and clinical efficacy of two groups were analyzed, liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil)], and tumor between the two groups. Markers [serum alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199)]and drug safety. Telephone and outpatient follow-up were conducted on patients after treatment, calculate the disease progression rate and mortality rate of two groups of patients, and follow up until the patient′s condition progresses or until March 1, 2024. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), t-test was used between the two groups. Chi-square test was used between the two groups of count data. Results:The objective response rate of TACE group was 27.78%, while that of HAIC group was 52.78%. The objective response rate of HAIC group was higher, and the difference between the two groups was statistically significant ( P<0.05); Before treatment, the levels of AST, ALT, and TBil in the two groups were compared, with P>0.05; After treatment, the AST of the TACE group was (36.65±4.80) U/L, ALT was (55.40±5.90) U/L, and TBil was (19.65±2.25) μmol/L, while the HAIC group was (25.95± 4.92) U/L, (41.15±6.15) U/L, and (14.40±2.13) μmol/L, respectively. The levels of various indicators in the HAIC group were lower, and the difference between the two groups was statistically significant ( P<0.05); Before treatment, there was no statistically significant difference in the levels of AFP, CEA, and CA199 between the two groups ( P>0.05); Before treatment, there was no statistically significant difference in the levels of alpha fetoprotein, carcinoembryonic antigen, and CA199 between the two groups ( P>0.05); After treatment, the levels of alpha fetoprotein, carcinoembryonic antigen, and CA199 in the TACE group were (152.50±20.10) ng/mL, (3.93±1.42) ng/mL, and (20.35±3.50) IU/mL, respectively, while those in the HAIC group were (102.35±18.10) ng/mL, (2.85±1.26) ng/mL, and (21.48±3.31) IU/mL, respectively. The levels of alpha fetoprotein and carcinoembryonic antigen in the HAIC group decreased more significantly ( P<0.05); The incidence of adverse reactions in the TACE group was 33.33%, while in the HAIC group it was 25.00%. There was no statistically significant difference in the incidence of adverse reactions between the two groups ( P>0.05). All patients completed treatment. In the TACE group, there were 4 cases of disease progression and 1 case of death, with an incidence of adverse prognosis of 13.89%. In the HAIC group, there was 1 case of disease progression and no death, with an incidence of adverse prognosis of 2.78%. There was no statistical significance between the two groups( P=0.088). Conclusion:For liver cancer patients, the combination of HAIC+ Sintilimab+ Lenvatinib is more effective in improving liver function and tumor marker levels compared to the combination of HAIC+ Sintilimab+ Lenvatinib.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors of the digestive tract in the world, with high malignancy, strong invasion, high postoperative recurrence rate and low overall survival rate. Transcatheter arterial chemoembolization (TACE) has been recognized as one of the most commonly used local treatment methods for liver cancer. For high risk of recurrence (such as the diameter of the tumor larger (> 5 cm in diameter), preoperative AFP levels, and large vascular invasion, with microvascular invasion, etc.) after radical resection of liver cancer patients, Postoperative adjuvant transarterial chemoembolization (PA-TACE) can bring benefits to the prognosis of patients with liver cancer.At the same time, TACE combined with other therapies such as antiviral therapy, molecular targeted therapy, immunotherapy, ablative radiation therapy and traditional Chinese medicine therapy have shown good efficacy. This article reviews the research progress of adjuvant therapy based on PA-TACE after radical resection of hepatocellular carcinoma.

Objective:To explore the application effect of integrated Chinese and Western medicine nursing based on the individual and family self-management theory (IFSMT) in patients with urinary incontinence after stroke, and provide reference for clinical nurses to effectively rehabilitate these patients.Methods:This was a quasi-experimental study. A total of 136 patients with urinary incontinence after stroke who were hospitalized in the Department of Encephalopathy of Shanxi Acupuncture and Moxibology Hospital from February 2022 to May 2023 were selected as the study objects by convenience sampling method. The subjects were divided into the control group and the experimental group with 68 cases in each group by random number table method. The control group received routine rehabilitation nursing, and the experimental group received integrated Chinese and western medicine nursing based on IFSMT on the basis of routine rehabilitation nursing. Urinary status, activities of daily living and quality of life of 2 groups were compared.Results:Ultimately, there were 68 cases were admitted in each group. In the control group, male 45 cases, female 23 cases, aged (62.35 ± 4.94) years old. In the experimental group, male 49 cases, female 19 cases, aged (61.94 ± 5.02) years old. There was no statistical significance in urinary status, activities of daily living and quality of life scores between the 2 groups before the intervention (all P>0.05). After the intervention, the average daily urination frequency of experimental group was (7.94 ± 1.08) times, which was lower than that of control group (9.88 ± 1.09) times; the average daily frequency of incontinence in the experimental group was (3.63 ± 1.65) times, lower than (5.03 ± 3.35)times in the control group; the average daily urine volume of experimental group was (107.34 ± 4.15) ml, higher than (89.62 ± 19.71) ml of control group, and the differences were statistically significant ( t=10.46,3.09, -7.23, all P<0.05). The scores of activities of daily living in the experimental group was (60.44 ± 3.65) points, which were higher than (46.24 ± 3.29) points in the control group; the Incontinence Quality of Life Questionnaire score of experimental group was (80.38 ± 4.65) points, which was higher than (64.62 ± 5.62) points of control group; Insomnia Severity Index-Short Form score of the experimental group was (10.94 ± 5.17) points, which was lower than (12.85 ± 4.30) points of the control group, and the differences were statistically significant ( t=23.85, -17.86, 2.34, all P<0.05). Conclusions:Integrated Chinese and western medicine nursing intervention based on IFSMT has a positive effect on patients with urinary incontinence after stroke, and can significantly improve patients' urination and daily living activities, thus improving patients' quality of life.

Hepatocellular carcinoma is one of the most common malignant tumors in clinical practice, and China has the highest incidence in the world. Spontaneous rupture of hepatocellular carcinoma is a serious complication of hepatocellular carcinoma. Its mechanism and risk factors are complex, including tumor size, location, hypertension, cirrhosis, HBsAg positivity, obesity and receiving targeted therapy with sorafenib, which may be its influencing factors. In recent years, the treatment methods of rupture and hemorrhage of hepatocellular carcinoma have been continuously improved and developed, including conservative treatment, transcatheter arterial chemoembolization, emergency hepatectomy, staged hepatectomy, etc.Transcatheter arterial chemoembolization followed by selective surgery is the most effective treatment at present. This article reviews the risk factors and treatment progress of rupture and hemorrhage of hepatocellular carcinoma, in order to provide reference for the direction of research on rupture and hemorrhage of hepatocellular carcinoma, so as to improve the prognosis and prolong the survival time of patients with early detection, early prevention and early treatment.

Abstract OBJECTIVE To clarify the resource status and diversity of endemic medicinal plants in Shaanxi province. METHODS The species specificity, species composition, faunal composition, family and genus types, medicinal value and endangerment degree of endemic medicinal plants in Shaanxi province were studied by literature review.RESULTS There were 713 species of 331 genera and 101 families endemic to Chinese medicinal plants in the study area. Fifteen species were naturally distributed only in Shaanxi province, and the remaining 698 species were also naturally distributed in other provinces of China. Among the 713 species, 233 species(69 families, 159 genera) were not collected from the fourth resource census in Shaanxi province. There were 11 species of pteridophytes in 7 families and 11 genera, 14 species of gymnosperms in 4 families and 10 genera, 627 species of dicotyledons in 82 families and 278 genera, and 59 species of monocots in 8 families and 32 genera. The endemic life forms of medicinal plants in the study area were mostly herbaceous, followed by shrubs and trees, and semi-shrubs and epiphytes accounted for the least. There were 9 families with ≥ 20 species and 4 families with ≥ 10 species in the study area. The 90 families belonging to the endemic species of medicinal plants in Shaanxi province were divided into 13 distribution types and 9 variations, and the tropical distribution(2-7 categories) had a total of 34 families. There were 5 endemic species of medicinal plants in the study area under the national class I key protection, and 14 species under the national class II key protection. There were 26 species of plants under local key protection in Shaanxi province. There were 21 plants that could be used as original plants for medicinal materials included in the Pharmacopoeia of the People's Republic of China(2020 edition). CONCLUSION The endemic species of medicinal plants in Shaanxi province are rich in resources and have good medicinal value. However, the growing environment of some plants is harsh and human damage is serious. Multiple protection measures should be taken to maintain the species diversity and sustainable development of resources in the study area.

Objective:To investigate the clinical effect of laparoscopic common bile duct exploration through Micro-incision of cystic duct and its junction in for choledocholithiasis.Methods:The clinical data of 62 patients with cholecystolithiasis complicated with choledocholithiasis treated in the Department of hepatobiliary and pancreatic surgery of Huangshi Central Hospital, Edong Healthcare Group from January 2017 to December 2021 were analyzed retrospectively, and were divided into two groups according to different treatment schemes. Among them, 32 cases underwent laparoscopic cholecystectomy, common bile duct exploration and lithotomy (primary suture group), Laparoscopic choledocholithotomy and exploration + T-tube drainage (T-tube Drainage Group) 30 cases. The general data, operation time, intraoperative bleeding, postoperative exhaust time, first time out of bed, postoperative hospital stay, 24-hour postoperative pain score and the incidence of total complications were compared between the two groups.Results:The operation was successfully performed in both groups, there was no perioperative death.There was no significant difference in general data, operation time, intraoperative bleeding and the incidence of total complications between the two groups ( P> 0.05), the postoperative anal exhaust time, the first time out of bed and the postoperative hospital stay in the primary suture group were (20.3±5.8) h, (15.5±4.3) h and (4.5±1.7) d, respectively, which were significantly shorter than those in the T-tube drainage group (28.3±7.9) h, (22.8±6.7) h and (7.0±2.8) d( P<0.05); The hospitalization cost in the primary suture group was (18 725.9±855.8) yuan, which was significantly lower than that in the T-tube drainage group (23 450.7±975.4) yuan ( P< 0.05). The 24-hour pain score (2.7±0.9) scores in the primary suture group was significantly lower than that in the T-tube drainage group (3.8±1.2) scores ( P< 0.05). Conclusion:Laparoscopic common bile duct exploration through micro-incision of cystic duct and its junction is safe and effective, which can accelerate the rehabilitation of patients and reduce the cost of hospitalization, which is more in line with the concept of ERAS.

Objective:To investigate the clinical application and efficacy of laparoscopic splenectomy combined with disconnection in megalosplenia and portal hypertension.Methods:The clinical data of 58 patients with splenomegaly of portal hypertension treated in the Department of Hepatobiliary and Pancreatic Surgery of Huangshi Central Hospital of Eastern Hubei Medical Group from January 2016 to January 2020 were analyzed retrospectively, they were divided into laparoscopy group ( n=34) and laparotomy group ( n=24), Laparoscopic splenectomy combined with devascularization was performed in the laparoscopic group, and open splenectomy combined with devascularization was performed in the open group.The general data, operation time, intraoperative bleeding, postoperative exhaust time, postoperative hospital stay and the incidence of postoperative complications (abdominal bleeding, B/C pancreatic leakage, abdominal infection, etc.) were compared between the two groups. The measurement data obeying normal distribution was expressed by mean±standard deviation ( Mean± SD), and the t test was used comparison between groups, and the chi-square test or Fisher exact probability was used comparison between enumeration data. Results:The surgery was successful in both two groups. 2 cases in the laparoscopic group were converted to laparotomy, There was no death in perioperative period.The operation time of laparoscopy group was (205.3±28.6) min and that of laparotomy group was (156.4±20.7) min, which was significantly longer than that of laparotomy group ( P=0.012). The intraoperative bleeding volume of laparotomy group was (327.2±39.5) mL, which was significantly higher than that of laparoscopy group (246.5±32.3) mL. there was significant difference between the two groups ( P<0.05). The postoperative exhaust time and postoperative hospital stay in the laparoscopic group were (2.6±1.4) d and (9.7±2.3) d, the laparotomy group were (3.8±1.5) d and (12.9±2.7) d respectively. The laparoscopy group was shorter than the laparotomy group. The difference between the two groups was statistically significant ( P<0.05). There were 0 case of abdominal bleeding, 2 cases of B/C pancreatic leakage and 3 cases of abdominal infection in the laparoscopic group, 1 case of abdominal bleeding, 2 cases of B/C pancreatic leakage and 5 cases of abdominal infection in the open group. The incidence of postoperative complications in the laparoscopic group was lower than that in the open group, but there was no significant difference between the two groups( χ2=2.807, P=0.088). Conclusions:Laparoscopic splenectomy combined with devasculation is safe and feasible, with advantages such as little trauma, quick recovery of postoperative intestinal function and short hospital stay, which benefit patients. However, the operation is difficult and requires high technical and psychological quality of surgeons.

Results of the IMbrave150 clinical study showed that atezolizumab plus bevaci-zumab have better overall survival and progression-free survival than sorafenib in the treatment of hepatocellular carcinoma patients. However, hepatocellular carcinoma patients with esophageal varices were not included in the IMbrave150 clinical study mainly considering the bleeding risk of patients undergoing treatment of bevacizumab. The authors introduce the atezolizumab plus bevaci-zumab treatment of an advanced hepatocellular carcinoma patient with moderate esophageal varices. By reducing the dose of bevacizumab, the patient achieved an excellent curative effect.