By systematically combing ancient and modern literature， this paper examined Tribuli Fructus and Astragali Complanati Semen（ACS） used in the famous classical formulas from the aspects of name， origin， production area， harvesting and processing， clinical efficacy， so as to provide a basis for the development of famous classical formulas containing such medicinal materials. The results showed that the names of Tribuli Fructus in the past dynasties were mostly derived from its morphology， and there were nicknames such as Baijili， Cijili and Dujili. The name of ACS in the past dynasties were mostly originated from its production areas， and there were nicknames such as Baijili， Shayuan Jili and Tongjili. Because both of them had the name of Baijili， confusion began to appear in the Song dynasty. In ancient and modern times， the main origin of Tribuli Fructus were Tribulus terrestris， and ancient literature recorded the genuine producing areas of Tribuli Fructus was Dali in Shaanxi and Tianshui in Gansu， but today it is mainly cultivated in Anhui and Shandong. The fruit is the medicinal part， harvested in autumn throughout history. There is no description of the quality of Tribuli Fructus in ancient times， and the plump， firm texture， grayish-white color is the best in modern times. Traditional processing methods for Tribuli Fructus included stir-frying and wine processing， while modern commonly used is purified， fried and salt-processed. The ancient records of Tribuli Fructus were spicy， bitter， and warm in nature， with modern research adding that it is slightly toxic. The main effects of ancient and modern times include treating wind disorders， improving vision， promoting muscle growth， and treating vitiligo. The mainstream base of ACS used throughout history is Astragalus complanatus. Ancient texts indicated ACS primarily originated from Shaanxi province. Today， the finest varieties come from Tongguan and Dali in Shaanxi. The medicinal part is the seed， traditionally harvested in autumn. Modern harvesting occurs in late autumn or early winter， followed by sun-drying. Ancient texts valued seeds with a fragrant aroma as superior， while modern standards prioritize plump， uniform and free of impurities. Traditional processing methods for ACS included frying until blackened and wine-frying， while modern practice commonly employs purification methods. In terms of medicinal properties， the ancient and modern records are sweet and warm in nature. Due to originally classified under Tribuli Fructus， its effects were thus regarded as equivalent to those of Tribuli Fructus， serving as the medicine for treating wind disorders， additional functions included tonifying the kidneys and treating vitiligo. The present record of its efficacy is to tonify the kidney and promote Yang， solidify sperm and reduce urine， nourish the liver and brighten the eye， etc. Based on the textual research results， it is suggested that when developing the famous classical formulas of Tribuli Fructus medicinal materials， we should pay attention to the specific reference object of Baijili， T. terrestris and A. complanatus should be identified and selected， and the processing method should be in accordance with the requirements of the formulas.

OBJECTIVES: Genetic mutation is one of the important causes for tumor genesis and development, but genetic mutation in nasopharyngeal carcinoma (NPC) has rarely been reported. This study explored the role of phosphatidylinositol 3 kinase-protein kinase B (PI3K-Akt), mammalian target of rapamycin (mTOR), and adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) signaling pathway in the efficacy and prognosis in patients with NPC. METHODS: A total of 31 patients with advanced NPC, who came from the Affiliated Cancer Hospital of Xiangya School of Medicine of Central South University/Hunan Provincial Cancer Hospital, were enrolled. All of the exons of 288 genes, introns of 38 genes and promoters or fusion breakpoint regions from the nasopharyngeal biopsy tissues before treatment were detected by the gene sequencing platform Illumina NextSeq CN500. The coding regions of 728 genes were carried out a high-depth sequencing of target region capture, and the 4 variant types of tumor genes (including point mutations, insertion deletions of small fragments, copy number variations, and currently known fusion genes) were detected. All of 31 patients received platinum-based induction chemotherapy combined with concurrent chemoradiotherapy and were followed up for a long time. RESULTS: The 3-year regional failure-free survival (RFFS) and disease-free survival (DFS) in patients with PI3K-Akt pathway mutation were significantly lower than those in unmutated patients (χ²=6.647, P<0.05). The 3-year RFFS and DFS in patients with mTOR pathway mutations were significantly lower than those in unmutated patients, and there was significant difference (χ²=5.570, P<0.05). The rate of complete response (CR) in patients with unmutated AMPK pathway was significantly higher than that in patients with mutation at 3 months after treatment (P<0.05), and the 3-year RFFS and DFS in patients with AMPK pathway mutation were significantly lower than those in unmutated patients (χ²=4.553, P<0.05). PI3K-Akt/mTOR/AMPK signaling pathway mutations and pre-treatment EB virus DNA copy numbers were independent prognostic factors for 3-year RFFS and DFS in patients with NPC (both P<0.05). CONCLUSIONS The NPC patients with PI3K-Akt/mTOR/AMPK signaling pathway mutation have poor prognosis, and the detection of PI3K-Akt, mTOR, AMPK driver genes and signaling pathways by next-generation sequencing is expected to provide new idea for basic research and targeted therapy of NPC.
AMP-Activated Protein Kinases/metabolism* ; DNA Copy Number Variations ; Humans ; Mutation ; Nasopharyngeal Carcinoma/genetics* ; Nasopharyngeal Neoplasms/metabolism* ; Phosphatidylinositol 3-Kinases/metabolism* ; Prognosis ; Proto-Oncogene Proteins c-akt/metabolism* ; Signal Transduction ; Sirolimus ; TOR Serine-Threonine Kinases/metabolism*

Objective? To analyze the risk factors of intracranial infection among children after fourth ventricle tumor resection and to summarize the effective nursing intervention. Methods? Retrospective analysis was carried out in 153 children with fourth ventricle tumor in neurosurgery at Beijing Tiantan Hospital of Capital Medical University from June 2013 to June 2017. All of the children were divided into infection group (n=45) and non-infection group (n=108) according to whether complicated with intracranial infection after surgery. From nursing viewpoint, we compared the differences in related factors of children with fourth ventricle tumor resection between two groups before, during and after surgery. Logistic regression was used to analyze the risk factors of intracranial infection. Results? Single factor analysis showed there were statistical differences in the hospital day before surgery ＞ 5 days (χ2=5.418, P=0.020), operative time ≥4 hours (χ2=4.189, P=0.041) and subcutaneous hydrops (χ2=4.452, P=0.049) among children between two groups. However, there were no statistical differences in ages, types of tumor, diameter of tumor, remains after tumor resection, adhesion between tumor and fourth ventricle, operative season, history of brain surgery, distributary of ventriculoperitoneal before surgery, setting external drainage, hypoalbuminemia and usage of glucocorticoid after surgery (P＞ 0.05). Logistic regression analysis showed that the risk factors influencing intracranial infection of children after fourth ventricle tumor resection included the hospital day before surgery＞ 5 days (OR=4.340, P=0.010) and subcutaneous hydrops (OR=9.169,P=0.011). Conclusions? Hospital day before surgery ＞ 5 days and subcutaneous hydrops can increase the incidence of intracranial infection among children after fourth ventricle tumor resection. Medical staff should improve their cognition on risk factors of infection among children after fourth ventricle tumor resection and take targeted nursing intervention.

Objective To evaluate the safety and efficacy of robot﹣assisted laparoscopic living donor nephrectomy. Methods Clinical data of 31 donors and recipients undergoing robot﹣assisted laparoscopic living donor nephrectomy in Xijing Hospital of the Fourth Military Medical University from November 2013 to August 2015 were retrospectively analyzed. Results Donor nephrectomy was successfully performed in 31 cases.The operation time ranged from 110 to 190 min.Intraoperative hemorrhage volume was measured as 20﹣100 ml.The warm ischemia time of the donor kidney was 100 to 160 s.The retained length of renal vein was between 1.8 and 3.0 cm and the length of renal artery was 1.4 to 2.3 cm.In 2 cases,spleen injury occurred during the kidney extraction and was treated with splenorrhaphy.One donor had postoperative hemorrhage,which was treated with hemostasis and anemia correction.Thirty one donors received postoperative follow﹣up for over 6 months.No long﹣term complications were observed.Among 31 recipients,one patient had delayed recovery of renal graft function and the serum creatinine level returned to normal range after treatment at postoperative 1 month.The survival rate of kidney grafts was up to 100%. Conclusions Robot﹣assisted laparoscopic living donor nephrectomy is a safe and efficacious surgical procedure for kidney resection,which possesses the advantages of small trauma,rapid recovery and no influence upon renal function.