This article systematically analyzes the historical evolution of the name， origin， quality evaluation， harvesting， processing and other aspects of Picrorhizae Rhizoma by referring to the medical books， prescription books， and other documents of the past dynasties， combined with relevant modern research materials， in order to provide a basis for the development and utilization of famous classical formulas containing this medicinal herb. The research results indicate that Picrorhizae Rhizoma was first recorded in New Revised Materia Medica from the Tang dynasty. Throughout history， Huhuanglian has been used as its official name， and there are also aliases such as Gehu Luze， Jiahuanglian and Hulian. The main source of past dynasties is the the rhizomes of Picrorhiza kurrooa and P. scrophulariiflora. In ancient times， Picrorhizae Rhizoma was mainly imported by foreign traders via Guangzhou and other regions， and also produced in China， mainly in Xizang. In ancient times， it was harvested and dried in early August of the lunar calendar， while in modern times， it is mostly harvested from July to September， with the best quality being those with thick and crispy rhizomes without impurities， and bitter taste. Throughout history， Picrorhizae Rhizoma was collected， washed， sliced， and dried before being used as a raw material for medicine， it has a bitter and cold taste， mainly used to treat bone steaming， hot flashes， infantile chancre fever， and dysentery. There is no significant difference in taste and efficacy between ancient and modern times. Based on the research results， it is recommended that the rhizomes of P. scrophulariiflora in the 2020 edition of Chinese Pharmacopoeia， or the rhizomes of P. kurrooa， can be used in famous classical formulas containing this medicinal herb， which can be processed according to the processing requirements marked by the original formula. For those without clear processing requirements， the dried raw products are used as medicine.

This article systematically analyzes the historical evolution of the name， origin， medicinal parts， processing and other aspects of Euphorbiae Pekinensis Radix（EPR） by referring to the herbal medicine， medical books， prescription books and other documents of the past dynasties， combined with the relevant modern research materials， so as to provide a basis for the development and utilization of famous classical formulas containing this herbal medicine. According to research， EPR was first recorded in the Shennong Bencaojing in the name of Daji， and it is the correct name of the herbal medicine in all dynasties， there are also other aliases such as Qiongju， Hongya Daji， and Xiamaxian. The dried roots of Euphorbia pekinensis from Euphorbiaceae was the mainstream of the past dynasties. Before the Ming dynasty， the above ground parts of E. pekinensis were used as Zeqi in herbal works. However， since LI Shizhen in the Ming dynasty proposed that the origin of Zeqi should be E. helioscopia， the aerial part of EPR is no longer used as medicine. Since modern times， the roots of Knoxia valerianoides has been used as EPR， and has become the mainstream of commodities， which should be corrected. Throughout history， it has been recorded that the main producing areas were Jiangsu， Anhui， Zhejiang， Shanxi and other regions， while modern botanical survey have shown that EPR is a widespread species distributed throughout the country. In ancient times， the harvesting time of EPR was mostly the twelfth lunar month， while in modern time， it is more common to harvest in autumn and winter. The main processing methods of EPR in ancient times were vinegar processing， wine processing， and stir frying， while in modern times， it is uniformly vinegar processing. In the medicinal properties and clinical aspects， the records are basically consistent throughout history， mainly characterized by bitter taste， cold and toxic nature. Its main efficacy is expelling water retention and reducing swelling. Based on the textual research， it is suggested to choose the dried roots of E. pekinensis when famous classical formulas containing EPR， processing method can be based on the original specified prescription requirements， if the processing method is not clear， it is recommended to use vinegar-processed products as medicine.

There is a substantial unmet need for treatments in the field of pediatric rare diseases, and investigator initiated trial(IIT) provide a critical pathway for testing and developing new drugs or treatment strategies. However, healthcare institutions, when conducting such research, must address compliance risks related to project approval, contract management, data protection, and conflict of interest management. This study aims to analyze the particularities and challenges of IIT in pediatric rare diseases, review relevant regulations and regulatory requirements, and provide healthcare institutions with a reference framework for compliance risk management to maximize the benefits of IIT. Based on literature review, analysis of laws and regulations, practical work experience, and frameworks from other institutions, we summarize the unique aspects of pediatric rare disease IIT in terms of participant characteristics, innovative technologies, and organizational structures.On this basis, targeted compliance management recommendations are proposed, which include establishing a risk rating and full-cycle risk monitoring mechanism, a consent and ethical review mechanism tailored to pediatric participants, a robust contract management mechanism, a comprehensive data security management mechanism, and a multidisciplinary team and multi-channel compensation mechanism. The study concludes that healthcare institutions, funders, and other collaborating entities should implement compliance management in line with the characteristics of IIT to ensure the safety and effectiveness of research and facilitate innovation and development in the treatment of pediatric rare diseases.

Asthma is a chronic inflammatory respiratory disease involving multiple cells and cellular components， characterized by recurrent episodes of wheezing， shortness of breath， chest tightness， and coughing， significantly impacting patients' quality of life. The phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway， as a crucial hub in intracellular signaling， is widely involved in the regulation of cell growth， proliferation， survival， metabolism， and a series of pathophysiological processes. Its regulatory role in the pathological progression of asthma is particularly significant， specifically in promoting airway inflammation， mediating epithelial mesenchymal transition， accelerating airway remodeling， regulating cell autophagy， inducing mucus hypersecretion， and influencing immune response balance. This study analyzed potential molecular targets of the PI3K/Akt pathway， including activators such as cysteine proteinase inhibitor 1（CST1）， found in inflammatory zone 1（FIZZ1） and free fatty acid receptor 1（FFAR1）， and inhibitors such as human β-defensin-3（hBD-3）， disintegrins， metalloproteinase 33（ADAM33） and interleukin-27（IL-27）， and initially revealed the potential molecular mechanisms of traditional Chinese medicine（TCM） in asthma intervention. Based on this， the authors systematically summarized the efficacy and specific mechanisms of TCM monomers， compounds， and external treatments for asthma by regulating the PI3K/Akt signaling pathway through literature review and analysis， aiming at establishing a robust foundation for the wide application and advanced development of TCM in asthma treatment， offering innovative insights for clinical research and drug development of asthma.

Asthma is a chronic inflammatory respiratory disease involving multiple cells and cellular components， characterized by recurrent episodes of wheezing， shortness of breath， chest tightness， and coughing， significantly impacting patients' quality of life. The phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway， as a crucial hub in intracellular signaling， is widely involved in the regulation of cell growth， proliferation， survival， metabolism， and a series of pathophysiological processes. Its regulatory role in the pathological progression of asthma is particularly significant， specifically in promoting airway inflammation， mediating epithelial mesenchymal transition， accelerating airway remodeling， regulating cell autophagy， inducing mucus hypersecretion， and influencing immune response balance. This study analyzed potential molecular targets of the PI3K/Akt pathway， including activators such as cysteine proteinase inhibitor 1（CST1）， found in inflammatory zone 1（FIZZ1） and free fatty acid receptor 1（FFAR1）， and inhibitors such as human β-defensin-3（hBD-3）， disintegrins， metalloproteinase 33（ADAM33） and interleukin-27（IL-27）， and initially revealed the potential molecular mechanisms of traditional Chinese medicine（TCM） in asthma intervention. Based on this， the authors systematically summarized the efficacy and specific mechanisms of TCM monomers， compounds， and external treatments for asthma by regulating the PI3K/Akt signaling pathway through literature review and analysis， aiming at establishing a robust foundation for the wide application and advanced development of TCM in asthma treatment， offering innovative insights for clinical research and drug development of asthma.

Objective:To study the clinical value of enhanced recovery after surgery(ERAS) strategy combined with early intestinal fluid reinfusion among neonates receiving jejunostomy due to intestinal obstruction.Methods:From December 2018 to December 2022, neonates with intestinal obstruction receiving jejunostomy in the Department of Neonatal Surgery of our hospital were prospectively enrolled. They were randomly assigned into ERAS group and traditional treatment (TT) group after surgery. The ERAS group was treated with ERAS strategy plus early intestinal fluid reinfusion. The TT group was treated with conventional gastrointestinal decompression, analgesia as needed and enteric fluid reinfusion according to the amount of defecation. The postoperative parenteral nutrition (PN) duration (T pn), central venous catheter (CVC) duration (T cvc), daily weight gain, duration of postoperative hospital stay (T hos), complications and readmission rate within 30 days were compared between the two groups. Results:A total of 22 cases were included in the ERAS group and 20 cases were in the TT group. T pn [(22.6±9.4) d vs. (30.7±11.3) d], T cvc [(5.9±0.8) d vs. (9.9±2.1) d] and T hos [(26.8±9.8) d vs. (33.8±11.5) d] in the ERAS group were significantly shorter than the TT group ( P<0.05). No significant difference existed in daily weight gain between the two groups ( P>0.05). The incidence of postoperative gastrointestinal mucosal bleeding in the ERAS group was significantly lower than the TT group (13.6% vs. 45.0%)( P<0.05). No significant differences existed in the following items between the two groups: feeding intolerance, PN-associated cholestasis, CVC-related bloodstream infection, intestinal fluid reinfusion-related complications, premature closure of fistula and readmission rate within 30 days (all P>0.05). Conclusions:The application of ERAS strategy plus early intestinal fluid reinfusion in neonates with enterostomy is safe and feasible, which can reduce the postoperative durations of PN, CVC and hospital stay and accelerate the recovery.

This paper aimed to explain the clinical thinking of using the method of unblocking the bowels and harmonizing viscera. Based on theory of "viscera-bowels extraordinary connection" of The Gateway to Medicine （《医学入门》）， combined with the theoretical research， clinical practice and individual experience of ancient physicians， modern scholars， it is believed that viscera qi disorder caused by bowels qi blocking is the basic mechanism of insomnia. In clinic， it is common that gallbladder phlegm-heat harassing the heart spirit， stagnant blood and qi in stomach blocking the pericardium， turbid heat in large intestine causing fire and affecting liver， dampness insmall intestine trapping the spleen， water retention in the bladder drying up lungs， and the inhibited original qi of sanjiao damaging the kidney， which could be treated with Wendan Decoction （温胆汤）， Taohe Chengqi Decoction （桃核承气汤）， Chengqi-series Decoction （承气汤类方）， Linggui Zhugan Decoction （苓桂术甘汤）， Wuling Powder （五苓散）， Xiaochaihu Decoction （小柴胡汤）， respectively.

Objective:To analyze the dosimetric differences between gamma knife stereotactic body radiation therapy (SBRT) and linear accelerator-based SBRT for lung tumors by comparison to provide a theoretical basis for the selection of treatment strategies.Methods:Seven patients who underwent SBRT for lung tumors in the Cancer Center of Affiliated Zhongshan Hospital of Dalian University from January 2022 to May 2023 were enrolled. Plans of gamma knife SBRT (γ_SBRT) or linear accelerator-based SBRT plans (X_SBRT) were designed for the 13 lesions in the patients, with adjacent lesions in the same patient sharing one plan. As a result, 10 γ_SBRT plans and 10 X_SBRT plans were obtained. All lesions received 30-50 Gy of radiation in 5-10 fractions. Then, dosimetric parameters were analyzed and compared between γ_SBRT and X_SBRT plans, including the target coverage, gradient index (GI), conformity index (CI), maximum dose ( Dmax); mean dose ( Dmean), and minimum dose ( Dmin) of planning target volumes (PTVs); lung volumes receiving 20 Gy or more ( V20), 10 Gy or more ( V10), 5 Gy or more ( V5), 100% of the prescription dose ( V100%), and 50% of the prescription dose ( V50%); Dmean and the percentages of lung volume receiving doses of 20 Gy or more (Lung_ V20) and 5 Gy or more (Lung_ V5) of ipsilateral lung; Dmean and Lung_ V5 of contralateral lung; and Dmax values of the esophagus, spinal cord, and heart. Results:Compared to X_SBRT plans, γ_SBRT plans exhibited superior GI, V20, V10, V5, V50%, the Dmean, Lung_ V20, and Lung_ V5 of ipsilateral lung, the Dmean and Lung_ V5 of the contralateral lung, and the Dmax of esophageal and heart ( z = -2.81 to -1.99, P < 0.05), higher Dmax and Dmean of PTVs ( z = -2.80, -2.80, P < 0.05), and longer delivery time ( z=-2.70, P<0.05). Meanwhile, there was no significant difference in target coverage, CI, and Dmax of the spinal cord ( P > 0.05). Conclusions:Gamma knife SBRT plans can achieve sharper dose falloff outside target volumes than linear accelerator-based SBRT plans. Gamma knife radiosurgery is expected to reduce the radiation dose to low-dose areas around PTVs and normal lung tissue in SBRT for lung tumors. However, it significantly prolongs the delivery time.

Objective:To evaluate balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS) for the treatment of esophageal varices.Methods:From June 2019 to November 2020, cirrhotic patients with esophageal varices who received endoscopic injection sclerotherapy (EIS) in the First Affiliated Hospital of Anhui Medical University were enrolled in the study. The patients were randomly divided into the bc-EIS group and the traditional EIS group. The number of treatments to eradicate varicose veins, the dose of sclerosing agent used in the first treatment, the number of injection points in the first treatment, the rebleeding rate within 10 months after the operation and the incidence of complications or adverse reactions were compared between the two groups.Results:Ninety-two cases were initially included in the study, and 7 cases were excluded based on exclusion criteria. Finally, 85 cases were included in the data analysis, 47 in the bc-EIS group and 38 in the traditional EIS group. The first eradication rate, the second cumulative eradication rate and the third cumulative eradication rate were 82.98% (39/47), 91.49% (43/47) and 100.00% (47/47) in the bc-EIS group, and they were 10.53% (4/38) ( χ 2=44.125, P<0.001), 31.58% (12/38) ( χ 2=33.023, P<0.001) and 63.16% (24/38) ( χ 2=20.730, P<0.001), respectively in the traditional EIS group, and the differences were statistically significant. The treatment times of eradicating varicose veins in the bc-EIS group and the traditional EIS group were 1.25±0.60 and 3.21±1.41, respectively, with significant difference. The dosage of sclerosing agent in first treatment in the bc-EIS group and the traditional EIS group was 17.66±7.14 mL and 22.92±6.84 mL, respectively ( t=3.441, P=0.001). The numbers of initial injection points in the bc-EIS group and the traditional EIS group were 2.70±0.86 and 2.78±1.04, respectively and the difference was not statistically significant ( t=1.847, P=0.065). The rebleeding rates of the two groups within 10 months after the operation were 2.13% (1/47) and 18.42% (7/38) respectively ( χ 2=4.771, P=0.029). There were no serious complications in the two groups. The incidences of retrosternal pain, nausea and vomiting, abdominal distension and ulcer were 2.13% (1/47), 2.13% (1/47), 4.26% (2/47) and 0.00% (0/47) in the bc-EIS group, and in the traditional EIS group, they were 5.26% (2/38) ( χ 2=0.035, P=0.851), 5.26% (2/38) ( χ 2=0.035, P=0.851), 7.89% (3/38) ( χ 2=0.060, P=0.806) and 7.89% (3/38) ( χ 2=1.877, P=0.171), respectively, without significant difference. Conclusion:Bc-EIS is more effective than traditional EIS for the treatment of esophageal varices with lower postoperative rebleeding rate, which shows better clinical application value.

Objective:To investigate the clinical efficacy and safety of balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS) for esophageal varices in patients with cirrhosis.Methods:From December 2020 to April 2021, cirrhotic patients with esophageal varices who planned to receive endoscopic treatment in the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University were selected and randomly divided into the trial group (treated with bc-EIS) and the control group [treated with endoscopic variceal ligation (EVL)] through computer randomization. The varices eradication rate, rebleeding rate and postoperative adverse reactions in the two groups were studied.Results:During the study, 93 cases were initially included according to inclusion criteria, among which 9 cases were excluded by exclusion criteria. Finally, 84 cases were included for data analysis, with 42 cases in each group. The esophageal varices eradication rate after the first treatment in the trial group was 88.10% (37/42), which was significantly higher than that in the control group [33.33% (14/42)] ( χ2=26.40, P<0.001). The esophageal varices eradication rate after 1 to 2 times and 1 to 3 times of treatment in the trial group were both significantly higher than those in the control group [97.62% (41/42) VS 40.48% (17/42), χ2=29.47, P<0.001; 100.00% (42/42) VS 45.24% (19/42), P<0.001]. The maximum follow-up period was 6 months, and none of the patients had rebleeding in the trial group, and the rebleeding rate in the control group was 4.76% (2/42) ( P=0.494). The incidence of thoracic and abdominal discomfort, nausea and vomiting, and abdominal distension in the trial group and control group were 26.19% (11/42) and 35.71% (15/42) ( χ2=0.51, P=0.474), 2.38% (1/42) and 7.14% (3/42) ( χ2=0.26, P=0.608), and 4.76% (2/42) and 11.90% (5/42) ( χ2=0.62, P=0.430), respectively. No other adverse events such as infection, dysphagia, perforation, esophageal tracheal fistula, esophageal stenosis, or ectopic embolism occurred in any group. Conclusion:Bc-EIS is effective and safe for the treatment of esophageal varices in patients with cirrhosis, with a one-time varices eradication rate of more than 85%, and can be completely eradicated after 1 to 3 times of treatment.