ObjectiveTo study the pharmacological substances and mechanisms through which sesquiterpene ZH-13 from Aquilariae Lignum Resinatum improves neuroinflammation. MethodsBV-2 microglial cells were stimulated with lipopolysaccharide （LPS） to induce neuroinflammation. The cells were divided into the normal group， the model group， and the ZH-13 low- and high-dose treatment groups （10， 20 μmol·L^-1）. The model group was treated with 1 μmol·L^-1 LPS. Cell viability was assessed using the cell proliferation and activity assay （CCK-8 kit）. Nitric oxide （NO） release in the cell supernatant was measured using a nitric oxide kit （Griess method）. The mRNA expression levels of interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， inducible nitric oxide synthase （iNOS）， and interleukin-6 （IL-6） were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The phosphorylation of mitogen-activated protein kinase （MAPK） pathway proteins was assessed by Western blot. ResultsCompared with the model group， ZH-13 dose-dependently reduced NO release from BV-2 cells under LPS stimulation （P<0.05， P<0.01）. In the 20 μmol·L^-1 ZH-13 treatment group， the mRNA expression levels of IL-1β， TNF-α， iNOS， and IL-6 were significantly reduced compared to the model group （P<0.05， P<0.01）. In both the low- and high-dose ZH-13 groups， the expression of the inflammatory factor TNF-α and the phosphorylation of c-Jun N-terminal kinase （JNK） in the upstream MAPK pathway were significantly reduced （P<0.05）. After stimulation with the JNK agonist anisomycin （Ani）， both low- and high-dose ZH-13 treatment groups showed reduced phosphorylation of JNK proteins compared to the Ani-treated group （P<0.01）. ConclusionThe sesquiterpene compound ZH-13 from Aquilariae Lignum Resinatum significantly ameliorates LPS-induced neuroinflammatory responses in BV-2 cells by inhibiting excessive JNK phosphorylation and reducing TNF-α expression. These findings elucidate the pharmacological substances and mechanisms underlying the sedative and calming effects of Aquilariae Lignum Resinatum.

Powered by big data and artificial intelligence, the research and clinical application of treatment planning automation for radiation therapy are rapidly growing. The application and supervision of planning automation systems necessitate careful consideration of different levels of automation, as well as the context for use. For autonomous vehicles, the levels of automation have been defined at home and abroad. Nevertheless, no such definitions exist for radiotherapy planning automation. To promote and standardize the development of radiotherapy planning automation and initiate discussion within the community, we developed this recommendation with reference to the taxonomy of driving automation for vehicles and divided the radiotherapy planning automation into six levels (level 1 to 6).

Objective:To evaluate the clinical efficacy and safety of fecal microbiota transplantation(FMT)for the treatment of chronic functional constipation in the elderly.Methods:A total of 33 elderly patients with chronic functional constipation were included and given three sessions of FMT.Changes in fecal characteristics, constipation, mood and quality of life in these patients were evaluated using the Bristol stool form scale(BSFS), the constipation assessment scale(CAS), patient assessment of constipation symptoms(PAC-SYM), the Zung self-rating anxiety scale(SAS), the Zung self-rating depression scale(SDS), and the patient assessment of constipation quality of life(PAC-QOL)before and 12 weeks after treatment.The clinical efficacy was based on comparison between pre-and post-treatment results for each patient.Results:Clear improvement was achieved in 33 patients 12 weeks after treatment, compared with before transplantation.Post-treatment scores of the constipation assessment scale and symptom self-assessment questionnaire for patients with constipation were(8.9±1.2)scores and(26.5±2.4)scores, respectively, significantly lower than pre-transplantation scores of(12.2±1.1)scores and(32.4±2.4)scores( t=15.034, 13.904, both P<0.001). Similarly, post-treatment scores were also lower than pre-transplantation levels for the self-rating anxiety scale[(50.4±8.4)scores vs.(57.5±9.0)scores, t=10.333, P<0.001], the self-rating depression scale[(50.6±8.4)% vs.(55.0±10.5)%, t=5.301, P<0.001], and self-assessment questionnaire for quality of life[(88.2±7.3)scores vs.(103.7±7.3)scores, t=23.300, P<0.001]. Conclusions:FMT can improve fecal characteristics and constipation symptoms, relieve anxiety and depression, improve the quality of life, and provide a new option for the treatment for elderly patients with chronic functional constipation.

Objective: To compare the effectiveness before and after the adjustment of schistosomiasis control strategies in Nanjing City, so as to provide the evidence for improving schistosomiasis control interventions. Methods: The prevalence of Schistosomasis japonicum infections in humans, livestock, Oncomelania hupensis and sentinel mice was collected in Nanjing City from 1993 to 2018, and the prevalence of S. japonicum infections in humans, livestock, sentinel mice and O. hupensis, and the areas of snail habitats, areas of infected snail habitats and snail control areas were compared before (1993-2004) and after (2005-2018) the adjustment of schistosomiasis control strategies to evaluate the effectiveness. Results: The prevalence of S. japonicum infections in humans, livestock, O. hupensis and sentinel mice was 0.77% and 0.02% (χ2=6 430.634, P<0.001), 0.46% and 0.01% (χ2=344.401, P<0.001), 0.19% and 0.11% (χ2=239.685, P<0.001), and 34.35% and 1.56% (χ2=1 856.286, P<0.001) in Nanjing City before and after the adjustment of schistosomiasis control strategies, respectively. The median areas (interquartile range) of snail habitats, infected snail habitats and snail control were 4 175.37 (1 301.65) and 2 366.44 (885.27) hm2 (Z=-3.755, P<0.001), 870.49 (1 001.75) and 0 (158.89) hm2 (Z=-3.654, P<0.001) and 1 383.23 (793.57) and 5 031.94 (629.11) hm2 (Z=-4.320, P<0.001) in Nanjing City before and after the adjustment of schistosomiasis control strategies, respectively. Conclusions After the adjustment of schistosomiasis control strategies, remarkable effects on schistosomiasis control has achieved in Nanjing City, where the transmission of schistosomiasis was interrupted. Nevertheless, the strategy requires to be continued and improved to move towards elimination of schistosomiasis in Nanjing City.

Objective:To evaluate the visibility of intracranial deep medullary vein (DMV) by sensitivity weighted imaging (SWI), and explore its correlation with recent small subcortical infarct (RSSI).Methods:From March 2021 to May 2022, 277 patients with cerebral small vascular disease (CSVD) confirmed by cranial MRI in Department of Neurology, Third Hospital of Hebei Medical University, were consecutively enrolled. These patients were divided into RSSI group ( n=128) and non-RSSI group ( n=149) according to RSSI presence or not within one week of onset. According to the DMV scores, these patients were divided into mild-moderate DMV group (0-12 scores, n=199) and severe DMV group (13-18 scores, n=78). The clinical and imaging data of these groups were analyzed retrospectively and compared. Multivariate Logistic regression analysis was used to determine the correlation between DMV and RSSI, as well as the independent influencing factors for DMV grading. Results:The cerebral microbleed (CMB), periventricular white matter hyperintensity (WMH) scores, deep WMH scores, total WMH scores, total CSVD burden scores, and DMV scores in patients of the RSSI group were significantly higher than those in the non-RSSI group ( P<0.05); and patients in the RSSI group had significantly younger age and significantly lower high density lipoprotein cholesterol (HDL-C) level than those in the non-RSSI group ( P<0.05). Multivariate Logistic regression analysis showed that DMV score ( OR=1.142, 95%CI: 1.026-1.271, P=0.016) was an independent influencing factor for RSSI after adjusting for HDL-C and deep WMH scores. The severe DMV group had significantly older age, statistically higher percentages of patients having history of hypertension, CMB, lacuna and moderate to severe EPVS in basal ganglia, and significantly higher periventricular WMH scores, deep WMH scores, total WMH scores, and total CSVD burden scores as compared with the mild-moderate DMV group ( P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.101, 95%CI: 1.060-1.143, P<0.001) and total CSVD burden scores ( OR=3.589, 95%CI: 2.506-5.141, P<0.001) were independent influencing factors for DMV scores. Conclusion:DMV is involved in the mechanism of RSSI, and DMV visibility can be used as an indicator to diagnose RSSI and evaluate RSSI progression.

Objective To investigate the effect of iliac flap pedicled with superficial circumflex iliac artery and sartorius in the treatment of femoral neck fracture of the young adults.Methods From April,2012 to March,2017,50 cadaveric lower limbs were injected with red latex,and the origin,diameter,course and distribution of the superficial circumflex iliac artery and arteries of the sartorius were observed.The iliac flap pedicled with superficial circumflex iliac artery and sartorius was used to treat the femoral neck fracture in young adults in 11 cases.There were 9 males and 2 females with an average age of 34.5(ranged from 16 to 54) years.The fractures were classified ac cording to Garden:4 cases of type Ⅲ and 7 cases of type Ⅳ.Regular outpatient follow-up was made.Results The superficial circumflex iliac artery originated from the femoral artery and the initial diameter was (1.2±0.3) mm.The length of the superficial circumflex iliac artery to the anterior superior iliac spine was (8.8±1.3) cm.The superficial circumflex iliac artery run to the anterior superior iliac spine and sent 1-3 periosteal branches into the iliac crest.The sartorius originates from the anterior superior iliac spine,and its proximal artery arises from the superficial circumflex iliac artery and the femoral artery.Link-pattern arterial anastomosises were formed in sartorius by branches of adja cent vascular pedicles,which nourished the ilium flap.All incisions healed by first intention.All cases were followedup from 16 to 42 months,with an average of 32.3 months.All fractures healed for 3-7 months,with an average of 4.6 months.No fracture nonunion,femoral head necrosis and other complications occurred.Harris hip scores was 93.02± 5.33.Seven cases were excellent and 4 cases were good.Conclusion The iliac flap pedicled with superficial cir cumflex iliac artery and sartorius has rich blood supply,easily performed conducive to promoting fracture healing,and reducing the occurrence of femoral head necrosis.It is an effective method for the treatment of femoral neck fracture in young adults.

Objective To explore the application value of modified self-traction Overlap method in intrathoracic esophagogastrostomy of Ivor Lewis surgery.Methods The retrospective and descriptive study was conducted.The clinical data of 12 patients with lower esophageal carcinoma who underwent Ivor Lewis surgery in the Zhongshan Hospital of Fudan University from January to May 2018 were collected.There were 9 males and 3 females,aged from 50 to 73 years,with a median age of 61 years.Modified self-traction Overlap method was used for intrathoracic esophagogastrostomy during the surgery.The esophagus was pulled down with the ligature as traction and rotated clockwise by 45 degrees to perform side-to-side esophagogastric anastomosis.The common opening was closed by a laparoscopic linear cutting suturing device to form an esophagogastric Overlap triangle anastomosis,and finally the esophagus was disconnected.Observation indicators:(1) intraoperative and postoperative situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect survival situation and tumor recurrence and metastasis up to January 2019.Measurement data were described as M (range).Results (1) Intraoperative and postoperative situations:all the 12 patients underwent successful Ivor Lewis surgery,without conversion to open surgery.The operation time,time of tubular gastroesophageal anastomosis,volume of intraoperative blood loss,time to initial anal exsufflation and time for initial fluid diet intake were 145 minutes (range,125-189 minutes),20 minutes (range,16-35 minutes),98 mL (range,78-135 mL),4 days (range,3-5 days),6 days (range,5-7 days),respectively.All the patients had no complication.Patients underwent upper gastrointestinal iodine hydrography at 5 days after surgery,confirming no anastomotic leakage or stenosis.Patients recovered well and were discharged postoperatively.The duration of postoperative hospital stay was 8 days (range,7-11 days).(2) Follow-up situations:12 patients were followed up for 8.0-12.0 months,with a median time of 10.6 months.Patients survived well,with no tumor recurrence or metastasis.Condusion Modified self-traction Overlap method in thoracic esophagogastrostomy of Ivor Lewis surgery is safe and feasible for lower esophageal carcinoma,with easy operating

Objective: oevaluateclinical curative effect of oxiracetam injection in the treatment of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) . Methods: Methods 52 patients with DEACMP were randomly divided into the observation group and the control group, 27 cases in the observation group and 25 cases in the control group. The 2 groups were adopted the treatment to improve the cerebral microcirculation and other symptomatic, the observation group on the basis of treatment for the treatment of oxiracetam Injection. Quantitative electroencephalogram (QEEG) and event-related potential P300 were used to evaluate the therapeutic effects of the 2 groups before and after treatment. Results: After treatment, QEEG value and event related potential P300 in observation group were decreased with statistically significant, respectively (P<0.05) , compared with the control group after treatment, the observation group excepted the occipital lobe, left parietal lobe, left around central and other indicators, QEEG and P300 oflatent period was shortened while the bank widens with statistical significance (P<0.05) . Conclusion Olathe injection of DEACMP patients recovery have certain curative effect.

There is a high probability of scaphoid nonunion after scaphoid fracture, which can lead to wrist arthritis and further to progressive aggravation of joint function, seriously affecting daily life and work. Currently, there are a variety of treatment methods for scaphoid bone nonunion at home and abroad, and surgical treatment is the major option, which includes open surgery and arthroscopy assisted minimally invasive surgery. Different operative methods have corresponding indications and contraindications with different therapeutic effects. Arthroscopic assisted technique is novel, minimally invasive, and reliable. This article reviews the treatment methods of scaphoid nonunion, including screw internal fixation, non vascularized bone graft, vascularized bone graft, anastomotic vascularized bone graft, bone block resection, arthrodesis, and arthroscopic minimally invasive surgery, so as to provide references for clinical treatment of scaphoid nonunion.

Objective To investigate the effect of retrograde sartorius myocutaneous flap for reparing skin defects of leg.Methods In the anatomic study,50 cadaveric lower limb were injected with red latex and the origin,diameter,course,distribution and anastomosis of sartorius's arteries were observed.Arteriographies were made in 4 sides of fresh specimens to study the arterial anastomosis in sartorius.Based on anatomic research results,we designed the retrograde sartorius myocutaneous flap for reparing skin defects of leg.Results Nutrient arteries of sartorius represented segnental distribution,Link-pattern arterial anastomosises were formed in sartorius by branches of adjacent vascular pedicles.Cutaneous arteries and musculocutaneous arteries above deep fascia formed interlocking arterial anastomosises net which provided blood supply for the skin on sartorius.The arterial branches in the distal 2/5 of sartorius came from saphenous artery,composed an arterial network around knee joint,which consist of anatomic basis for the blood supply of retrograde sartorius myocutaneous flap.Form February,2010 to April,2014,the retrograde sartorius myocutaneous flap were used to repair skin defects of leg in 2 cases.The flap size ranged from 7 cn×18 cm to 12 cm×25 cm.All flaps survived successfully with no ulcer.2 cases were followed up for 7 to 16 months.The skin color and texture were satisfactory.Conclusion the retrograde sartorius myocutaneous flap has constantly,reliable blood supply,and easily performed.It is an effective method for the reconstruction skin defects of leg.