OBJECTIVE To explore the mechanism of Shenqi guben formula （SQGB） in improving cancer-related fatigue （CRF） based on network pharmacology and cellular experiments. METHODS Active components of SQGB and CRF-related targets were identified on the basis of databases such as the Traditional Chinese Medicine Systems Pharmacology platform. An in vitro CRF cell model was established by inducing A549 cells with interleukin-17 （IL-17）. Cells were treated with low （1.0 mg/mL） or high （1.5 mg/mL） concentrations of SQGB. The effects on cell viability， migration， apoptosis， inflammatory factors， mRNA expression， apoptosis-related proteins and key proteins 011） of IL-17 signaling pathway were evaluated using scratch assay， flow cytometry， ELISA， real-time fluorescent quantitative PCR and Western blot analysis. RESULTS SQGB contained 84 active components acting on 209 potential CRF targets. Among E-these， quercetin， kaempferol， and luteolin were identified as the core components of the compound. Core targets included tumor protein p53， AKT serine/threonine kinase 1， IL-6， and tumor necrosis factor （TNF）. IL-17， TNF and phosphatidylinositol-3- kinase-serine/threonine protein kinase （PI3K/Akt） signaling pathways were identified as crucial pathways. Compared with IL-17 intervention group， the cell migration rate， B-cell lymphoma 2 （Bcl-2） protein expression， the levels of IL-6 and TNF-α in the supernatant， mRNA expression of IL-17 receptor A （IL-17RA）， TNF-α， and IL-6， as well as the protein expression of IL-17RA and nuclear factor kappa-B p65 subunit （p65）， and phosphorylated （p）-p65/p65 ratio in IL-17+SQGB low- and high- quality concentration groups were all significantly decreased or down-regulation （P＜0.05）； the apoptosis rate， expression levels of Bcl-2 associated X protein （Bax） and cleaved caspase-3 protein， the ratio of Bax/Bcl-2， the expression level of p-p38 protein， and the p- p38/p38 ratio were all significantly increased or up-regulated （P＜0.05）. Moreover， the improvement effects of these indicators were mostly better in the high-quality concentration groups compared to the low-quality concentration groups （P＜0.05）. CONCLUSIONS SQGB ameliorates CRF by regulating the IL-17 signaling pathway， inhibiting the expression of inflammatory factors， and activating p38 MAPK-dependent apoptosis pathway.

BACKGROUND:Inherited heart disease has a high prevalence and mortality rate,but its pathogenesis has not yet been clarified.Although relevant animal models have been established to provide a foundation for the pathogenesis research of inherited heart disease,the value of these research results has been significantly reduced due to differences among species.Therefore,a new model is needed to explore its occurrence and development. OBJECTIVE:To review the current role of induced pluripotent stem cells in disease modeling and potential application prospects in various inherited heart diseases. METHODS:The first author searched the relevant articles published nearly 13 years in PubMed from January to March 2023.The search terms were"induced pluripotent stem cell,inherited heart disease,congenital heart disease".Finally,76 articles were included for analysis. RESULTS AND CONCLUSION:Since 2007,when induced pluripotent stem cells were induced from human somatic cells,many studies have been reported on disease-specific induced pluripotent stem cells.Due to the ability of disease-specific induced pluripotent stem cells to reproduce disease phenotypes,they are expected to become a new research tool for in vitro disease modeling,used to analyze pathogenesis and develop auxiliary drugs.In the research of cardiovascular genetic diseases,cardiomyocytes derived from patient-specific induced pluripotent stem cells contain gene mutations that are involved in cardiac dysplasia.Therefore,it can be used as a new tool to study the potential mechanisms of inherited heart disease.Up to now,induced pluripotent stem cells-derived cardiomyocytes have been widely used to study the molecular mechanisms of various genetic heart diseases,such as cardiac electrophysiological diseases,cardiomyopathy,and some syndromic inherited heart diseases.

Sepsis is one of the common severe diseases caused by the dysregulated host response to infection， which seriously threatens the life and health of human beings all over the world. The incidence and mortality of the disease are extremely high， and it has always been an urgent problem to be solved in the field of acute and critical diseases. At present， anti-infection， fluid resuscitation， mechanical ventilation and other programs are most used in clinic to treat sepsis， but their poor prognosis and high cost and other issues remain to be resolved. Therefore， it is necessary to explore a new， efficient， safe and inexpensive drug and treatment model at this stage. The treatment of traditional Chinese medicine （TCM） is based on syndrome differentiation and holistic concept. It can effectively regulate the progression of sepsis， maintain the homeostasis of the body， and has fewer adverse reactions. It has achieved good clinical results. In recent years， a large number of studies have shown that TCM can reduce the inflammatory response by regulating the Toll-like receptor 4（TLR4） signaling pathway， thereby reducing the severity and mortality of sepsis patients. However， there is still a lack of systematic exposition of TCM regulating TLR4 signaling pathway in the treatment of sepsis. Therefore， this article summarizes the relationship between TLR4 signaling pathway and sepsis and the mechanism of TCM in the disease by searching and consulting relevant literature in recent years. It is found that some Chinese medicine monomers and active ingredients， Chinese medicine compounds and Chinese medicine preparations can effectively reduce systemic inflammatory response， repair organ damage and improve the prognosis of sepsis by inhibiting the activation of TLR4 signaling pathway. However， due to various limitations， some studies have directly focused on the differential expression and function of TLR4， ignoring the downstream molecular expression and phenotypic effects of TLR4. The alternative mechanism， relationship and specific molecular mechanism of the pathway are still unclear. There are problems such as unclear pharmacokinetics and unclear mechanism in the pro- and anti-inflammatory balance， which need to be further studied and explored in order to provide new ideas for the potential treatment and drug development for sepsis.

Objective:To summarize our experience in diagnosis and treatment of Budd-Chiari syndrome(BCS) accompanied with hepatic nodules.Methods:The clinical data of 33 patients with BCS accompanied with hepatic nodules who were treated at Henan Provincial People's Hospital from January 2012 to December 2018 were retrospectively analysed. A total of 33 patients were enrolled, including 17 males and 16 females, with an average age of 51 years. Analyze the treatment and prognosis of different types of nodules.Results:Of 33 patients, 27 were diagnosed to have hepatocellular carcinoma and 6 benign proliferative nodules. Treatment of patients with hepatocellular carcinoma included, transcatheter arterial chemoembolization ( n=1) and hepatectomy ( n=26). The survival time of these patients with hepatocellular carcinoma ranged from 10.0 to 78.0 months (mean 37.8 months). For the remaining 6 patients with benign nodules, the nodules were multiple and no malignant changes were observed on follow-up. Conclusion:For patients with BCS associated with benign nodules, no specific treatment was required. Hepatocellular carcinoma assocated with BCS had good prognosis. An aggressive surgical resectional approach is recommended to treat and to relieve the hepatic outflow obstruction.

Objective:To study the safety and efficacy of using entrapped duct-to-mucosa pancreaticojejunostomy for patients with small pancreatic ducts of less than 3 mm in diameter.Methods:The clinical data of patients who underwent entrapped duct-to-mucosa pancreaticojejunostomy at Henan Province People's Hospital from January 2017 to December 2019 were retrospectively analyzed. The incidences of complication including pancreatic fistula and abdominal hemorrhage were studied. The duration to carry out the pancreaticojejunostomy and postoperative hospital study were also analyzed.Results:Of 98 patients included in this study, there were 58 males and 40 females, with an average age of 62.3 (aged 24 to 73) years. The average time of completing the pancreaticoenterostomy was (10.2±3.1) min. There were 10 patients (10.2%) who developed grade A pancreatic fistulae. There were no grade B or C pancreatic fistulae, no portoperative bleeding and no perioperative deaths. The postoperative hospital stay was (13.4±4.6) days.Conclusion:Entrapped duct-to-mucosa pancreaticojejunostomy was simple, quick, safe and effective in patients with small pancreatic ducts.

This paper aims to define the concept of autonomous learning and explore the purpose and significance of medical students' autonomous learning by combing the literature review at home and abroad in this field.Through analyzing the research progress and research methods of autonomous learning,this paper attempts to raise problems and provide countermeasures accordingly.In the current research of autonomous learning,researchers' perception of this study is insufficient.The scope of the current research is too limited and the research fields need to be further widened.In addition,the classification of disciplines in this subject is unbalanced and the coverage also needs to be further expanded.There are many theoretical studies but few empirical studies so far,and thus empirical research should be strengthened.

Objective To study the combined use of ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.Methods The clinical data of 7 patients with hilar cholangiocarcinoma who underwent ALPPS combined with hepatic arterial resection and reconstruction were analyzed retrospectively.The technical points and the perioperative management were analyzed.Methods At the first stage,the relationship between the tumor and the vessels were explored,the portal vein of the part of the liver to be resected was ligated and the liver was transected with a CUSA (Cavitron Ultrasound Surgical Aspirator).Then the bile duct was cut and a hepaticojejunostomy was completed.Finally,under ultrasound guidance,a bile duct drainage tube was inserted transhepatically into the part of the liver which was to be resected.Two to three weeks later,and after enough hypertrophy of the liver remnant size was confirmed,tumor resection was completed with reconstruction of the hepatic artery.Results Seven patients underwent the second stage operation,with no perioperative death.Six patients developed pulmonary infection and were treated successfully with conservative treatment.Two patients developed postoperative bile leak with secondary abdominal infection.One patient developed postoperative hepatic artery thrombosis secondary to biliary tract infection.Conclusion ALPPS combined with hepatic artery reconstruction was safe and feasible in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.

Objective To study the pathogenesis,diagnosis and treatment of pancreatic portal hypertension (PPH).Methods The clinical data of 37 patients with PPH treated in Henan Province People's Hospital from January 2008 to January 2016 were retrospectively analyzed.Result Nine patients underwent conservative treatment and 28 patients underwent surgical treatment.No deaths were observed in the perioperative and follow-up periods.One patient underwent a second operation becausc of gastrointestinal bleeding.The clinical symptoms of the remaining patients were significantly relieved after surgery.Conclusions Treatment should be individualized and directed at the underlying cause.The anatomy of the coronary vein and the location of obstruction of the splenic vein determined the degree of the variceal veins and the surgical methods.Splenectomy was the basic treatment for PPH.Subcapsular splenectomy was effective in some challenging cases.

Objective To discuss the diagnosis and surgical treatment of solid pseudopapillary tumor (SPTP) of the pancreatic head.Methods From January 2008 to August 2013,the clinicopathological data of 12 patients who were diagnosed and surgically treated in our hospital for this condition were analyzed retrospectively.Results There were 11 women and 1 man,the mean age was 28.7 years,with a range from 11 to 43.The mean diameter of the tumor was 7.5 cm(2 ～ 15 cm),6 of 12 of these tumors were more than 10 cm.Seven patients underwent pancreaticoduodenectomy,2 duodenum-preserving pancreatic head resection,2 local resection of tumor,1 palliative resection,1 pancreaticoduodenectomy combined with resection of part of the portal vein.All the diagnoses were confirmed by postoperative histopathology.In a follow-up which ranged from 3 to 65 months,all the patients were alive with no evidence of disease recurrence.Conclusions Most of the SPTPs of the pancreatic head were huge.The diagnosis was difficult.Complete tumor resection is the best treatment.

Objective To investigate the influence on right-to-left shunt (RLS) of patent foramen ovale with contrast transcranial Dopple (cTCD) in different positions.Methods 276 consecutive patients included ischemic cerebrovascular disease (ICVD),migraine,episodic vertigo and syncope.They underwent cTCD at rest and after Valsalva maneuver in 4 positions:upright sitting,supine,left lateral decubitus and right lateral decubitus,in random order.RLS was graded 0 (no microbubbles detected),1 (1-10microbubbles),2 (＞ 10 microbubbles but no curtain),and 3 (curtain,shower of microbubbles).Meanwhile,each patients was examined by contrast transthoracic echocardiography(cTTE),contrast transesophageal echocardiography (cTEE) or right heart catheterization.Results RLS detection rate was 48.2％ (133/276)through cTCD.They were also confirmed patent foramen ovale by 82 cases in cTTE,28 cases in cTEE,and 23 patients in right heart catheterization.At rest,RLS detection rate and microbubbles of 4 positions had no significant difference (P ＞0.05).After the Valsalva maneuver,RLS detection rate and microbubbles of each position were significantly higher than at rest (P ＜0.001),and the RLS detection rate and microbubbles in upright sitting were higher than that at rest(P ＜0.05).Conclusions RLS is best detected in the upright sitting position with Valsalva maneuver with cTCD.Upright sitting detection helps to improve the detection rate and microbubbles of RLS.