Ulcerative colitis(UC)is a common disease of the digestive system.Phosphatidylinositol-3-kinase(PI3K)/synuclein/threonine kinase(AKT)is closely related to cell survival,apoptosis,inflammation and other biological processes,and the expression levels of PI3K and AKT significantly increase during the course of UC,with accelerated apoptosis,improved inflammation,and damaged intestinal mucosal barrier function.In recent years,a large number of basic and clinical trials have been conducted on PI3K/AKT signaling pathway in TCM,and the results indicate that PI3K/AKT signaling pathway is expected to be an important potential target for UC treatment.This article analyzed the mechanism of the regulation of PI3K/AKT signaling pathway in TCM from monomer,extract,compound and acupuncture,and suggested that the regulation of this signaling pathway is of great significance for the prevention and treatment of UC,and provide reference for drug development.

【Objective】 To investigate the clinical efficacy of human acellular allogeneic dermis (HADM) in the repair of urinary fistula. 【Methods】 The clinical data of 12 female patients with complex vesicovaginal fistula treated during Jun.2021 and Nov.2022 were retrospectively analyzed. The patients’ average age was 47.3 years, ranging from 38 to 56 years. The body mass index (BMI) ranged from 16.6 to 25.2, with an average of 21.3. HADM was inserted between vagina and bladder wall fistula to repair fistula in all 12 patients. 【Results】 All operations were successful. After the operation, the vaginal urine leakage stopped and the urinary tube was retained for 2 weeks. During the postoperative follow-up of 1 to 16 months, no recurrence or complication were observed. 【Conclusion】 Transvaginal HDMA is an ideal surgical method in the treatment of complex vesicovaginal fistula, which has advantages of small trauma, fast recovery and high success rate.

【Objective】 To explore the diagnosis and choice of surgical treatment of paraurethral cyst in adults. 【Methods】 The clinical data of 56 patients with paraurethral cyst treated at our hospital during Dec.2011 and Jul.2022 were retrospectively analyzed. 【Results】 Of the 56 patients, most of the urethral masses were found during physical examination or bathing, and the time between finding of masses and admission was 2 days to 10 years. Two cases were diagnosed as vaginal wall mass, and one as ureal mass, which were confirmed by postoperative pathology as leiomyoma. Fifty-three cases were diagnosed as paraurethral cysts, 15 of whom underwent fenestration and 38 complete resection of the cyst wall. In the 38 cases who underwent complete resection of cyst wall, 6 had urethral damage due to large and deep cysts closely connected with the urethra, and catheter was indwelled for 10 to 14 days after surgery. All cases were cured without complications. There was no recurrence during the 2 months to 10 years of follow-up. 【Conclusion】 Paraurethral cysts are not difficult to diagnose. Large cysts are likely to damage the urethra due to repeated infection and close connection with urethra. We suggest that the large and deep paraurethral cysts should be removed with fenestration.

Objective:To analyze the distribution and composition characteristics of jellyfish stings in various coastal baths in Qinhuangdao City from 2017 to 2019, and to provide scientific basis for the prevention, control and early warning of jellyfish stings.Methods:Statistics and analysis of the age, gender, time of stings, location of injury, first symptoms, and playing time in the sea at the time of the sting, etc. of people with jellyfish stings in various bathing beaches along the coast of Qinhuangdao from 2017 to 2019 (July to August) were conducted.Results:The number of jellyfish stings in the coastal bathing beaches of Qinhuangdao City in 2017, 2018, and 2019 was decreasing year by year, with 1 890, 492, and 171 cases respectively. Among them, Qianshuiwan Bathing Beach and Dongshan Bathing Beach had more stings (60.90% and 35.08% respectively in 2017, 24.39% and 64.23% respectively in 2018, 16.96% and 16.42% respectively in 2019). There was no significant change in the gender and age distribution of jellyfish stings each year [57.99% males in 2017, with a median age of 13 (8, 31) years old; 63.21% males in 2018, with a median age of 25 (8, 29) years old; and 59.65% males in 2019, with a median age of 12 (7, 31) years old]. Stings were mainly located at the lower limbs (the proportion of lower limb injuries: 46.54% in 2018, 45.61% in 2019), followed by upper limbs (upper arm, elbow, forearm), trunk, etc. The first symptom was mainly pain (89.43% in 2018, 38.29% in 2019), followed by rash (64.43% in 2018, 59.43% in 2019), numbness, blisters, etc. Sting incidents mainly occurred from 13:00 to 17:59 (the proportion of sting incidents in this time period in 2018 and 2019 were 68.09% and 52.63%, respectively).Conclusions:Jellyfish stings in coastal baths in Qinhuangdao City are mainly distributed in Qianshuiwan Baths and Dongshan Baths. The management of these sea areas should be strengthened, and scientific publicity and medical rescue should be strengthened to prevent jellyfish stings in peak hours and related baths.

Objective:The clinical efficacy, safety and quality of life in female patients with stress urinary incontinence (SUI)treated by midurethral sling were studied by multicenter retrospective study.Methods:From January 2018 to December 2018, 531 female patients with severe stress urinary incontinence from seven domestic urinary center were included in this study, including 78 cases from General Hospital of Central Theater Command, 122 cases from Shanghai Jiao tong University School of Medicine Affiliated Ren Ji Hospital, 67 cases from Shanghai Jiaotong University Affiliated First People’s Hospital, 68 cases from People’s Hospital of Jiangsu Province, 71 cases from The First Affiliated Hospital of Xi’an Jiaotong University, 65 cases from Zhejiang Provincial People’s hospital, 60 cases from Xiamen University First Affiliated Hospital. Among the 531 patients, 214 cases received TVT sling with an average age of (58.14±10.16) years. 181 cases were in postmenopausal(84.6%). The number of births ≥2 times was 89 (41.6%) cases. The score of ICI-Q-SF was 16.00±1.73. There were 166 cases of moderate incontinence (77.6%) and 48 cases of severe incontinence (22.4%). There were 317 patients in the TOT/TVT-O group with an average age of (58.33±10.25) years. 247 cases were in postmenopausal(77.9%). The number of births ≥2 times was 120 (37.8%) cases. The score of ICI-Q-SF was 15.79±1.75. There were 256 cases of moderate incontinence (80.8%) and 61 cases of severe incontinence (19.2%). There was no statistically significant difference in general data parameters between the two groups ( P>0.05). 1, 6, 12 months after the operation, the two groups of patients incontinence questionnaire Summary(ICI-Q-SF), common complications and Patient Global Impression of Improvement(PGI-I), satisfaction evaluation follow-up. ICI-Q-SF score improved > by 50% (cure + significant improvement) and 1-hour pad test <10 g (qualitative index) were used as the evaluation index of surgical success. Result:Both of the two surgical methods have high successive rate. There was no significant difference between 94.9% (203/214) of the TVT group and 93.7% (297/317) of the TOT/ TVT-O group ( P>0.05). Postoperative improvement of urinary incontinence (cure rate) [88.3% (189/214)]in the TVT group was slightly higher than that in the TOT/ TVT-O group [77.0% (244/317)] ( P<0.05). There was no change in the recurrence rate of urinary incontinence in the follow-up 6 and 12 months after the operation. There was no statistically significant difference between 4.4% (9/203) in the TVT group and 5.4% (16/297) in the TOT/TVT-O group ( P>0.05). The subjective cure rate 12 months after the operation was 96.3% (206/214) in the TVT group and 95.9% (304/317) in the TOT/TVT-O group ( P>0.05). 10 patients occurred bladder perforation occurred in the TVT group, and no bladder perforation occurred in the TOT/TVT-O group ( P<0.001). The incidence of pain and discomfort in the TVT group was significantly lower at 1.9% than that in the TOT/TVT-O group at 6.9% ( P<0.01). There was no statistically significant difference between the two groups in the incidence of complications such as dysuria/urinary retention, frequent urination/urgency incontinence. Both of them exposed sling ( P>0.05). Conclusion:Both TVT and TOT/TVT-O sling can effectively treat female stress urinary incontinence, and both can improve the sexual satisfaction of patients after the surgery, with fewer complications and other advantages. The selection of specific surgical methods in clinical practice can be individualized according to the patient's physical conditions, clinical needs and the operation methods familiar to doctors.

Objective: To explore the clinical efficacy of female urethral diverticulum resection and reconstruction under the folding position. Methods: Retrospective analysis of 22 female patients with urethral diverticulum was performed from September 2010 to December 2018. There were 12 cases of simple diverticulum, 6 cases of horseshoe diverticulum, 4 cases of circumferential diverticulum, aged from 26 to 72 years, with an average of 46.2 years, whose BMI ranged from 24.2 to 34.8 kg/m², with an average of 30.4 kg/m². Eleven cases (50%) presented with dysuria, 10 cases (45.5%) with repeated urinary tract infections, 7 cases (31.2%) with difficulty of voiding, 10 cases (45.5%) with urethral secretion, 9 cases (40.1%) with difficulty of sexual intercourse, and 4 cases (18.2%) without symptoms. Unlike the traditional surgical procedure under the lithotomy position, the folding position was used to expose the vagina and separate the vaginal mucosa by longitudinal incision, and the diverticulum was completely removed to the neck. The peri-operative complications and efficacy were recorded. Results: All 22 cases underwent successful procedures, and were followed up for 25.2 months on average (ranged 8 to 42 months). One of them suffered from weak stream 2 months after operation, with residual urine volume of 100ml by ultrasonography. Her symptoms improved after dilatation of the urethra. Two cases suffered from different degrees of lower urinary tract storage symptoms 1 month after the operation (1 case of mild dysuria and 1 case of urinary tract infection), who improved after oral administration of levofloxacin tablets for 3-5 days. All patients had no urethral diverticulum recurrence 3 months later by ultrasonography, half a year by cystoscopy, and every six months by ultrasonography. Conclusions Surgical treatment is still the best choice for patients with urethral diverticulum. The success rate of transvaginal urethral diverticulum reconstruction with a Jackknife position is high, postoperative recurrence rate is low, and postoperative complications are few.

Objective To indentify the cognitive status of Chinese patients to acne and the influencing factors to theirs' cognitive status,so as to provide solid evidences for the prevention and treatment of acne.Methods A self-designed questionnaire was made to conduct this survey of 16,156 acne patients,who seeked to the treatment in the dermatological departments from 112 hospitals in China.The survey consisted of several parts,including the general status of patients,the patients' cognition of occurrence,development and risk factors of acne,whether the first choice was seeking treatment at the hospital when the patients had acne and the condition of selection of skin care products.The factors were analyzed,which could impact the cognition of the patients' behavior of treatment,how did the patients' cognition to influence their medical behavior and skin care as well as the consistency of assessment of the severity of acne by doctors and patients themselves.Results The acne patients studied had the best knowledge of "acne is a skin disease","it not only occurs in the period of adolescence" and "the disease can be prevented and cured",which accordingly accounted for 80.65％,69.16％ and 65.49％ of the total patients respectively.However,the awareness of acne patients to heredity,high sugar and dairy products as risk factors for acne was insufficient,which accounted for 48.72％,42.40％ and 18.25％ of the total patients,respectively.Gender,age,educational level,occupation and health knowledge were the main factors affecting the cognitive level of patients;the survey also found that men,patient with educational level of junior high or even lower educational condition,occupation of labor workers or farmers and patients were lack of health education with poor knowledge of the genetics and dietary were risk factors for acne;patients with age over 36 years or with mild illness had poor knowledge of dietary risk factors for acne;the difference was statistically significant (P＜0.05).The analysis of the influence of cognitive status on medical treatment behavior and skin care showed that the better the cognition,the higher the probability of patients would choose medical treatment as the first choice as well as choosing functional skin care products;the difference was statistically significant (P＜0.05).The consistency of assessment of the severity of acne by doctors and patients was poor (Kappa value ＜0.4),and the assessment of severity of acne by patients was more serious than doctors' assessment.Conclusions Patient's cognitive status will affect their medical behavior and skin care,and there is also a phenomenon that patients have a more serious assessment of their acne condition.It is suggested that health education for acne patients should be strengthened in clinical medicine so as to improve their knowledge of acne as well as preventing from acne effectively.

【Objective】To analyze the risk factors of progression to end-stage renal disease（ESRD）in patients with diabetic kidney disease（DKD），and screen the high-risk population for early prevention.【Methods】The clinical data of 231 patients with diabetic nephropathy in our hospital were collected and followed up for 3 years. According to whether ESRD occurred，they were divided into non-progressing ESRD group（133 cases）and ESRD group（98 cases）. Classification tree model was used to analyze the risk factors related to ESRD，and the high-risk population was screened by node gain analysis.【Results】Four important explanatory variables were screened out by the classification tree model from the candi⁃ date variables related to early renal damage，including apolipoprotein B（ApoB），gender，diabetic retinopathy，systemic blood pressure（SBP）. ApoB level was an important factor for DKD progression. For DKD patients with the chronic kidney disease （CKD）3~4 stageswith ApoB> 1.14 mmol/L，theprobabilityofprogression toESRDfor 3 yearswas 75.0 %，and ifat the same time with diabetic retinopathy，the probability was 79.7 %.【Conclusion】The classification tree model can analyze the risk factors of progression to ESRD in DKD patients effectively，to identify the characteristics of high-risk populations.

Objective To analyze the infiltration of inflammatory cells under the mucosa of female cystitis glandularis and the different inflammatory infiltration in different clinical pathological types of cystitis glandularis.Methods Immunohistochemical method was used to detect the bladder mucosal tissue samples of 10 female patients confirmed cystitis glandularis admitted from June 2016 to October 2016.The results of immunohistochemical staining were collected and statistically analyzed by the automatic microscopy and image analysis system.In addition,the clinical data and tissue sample of 49 cases of cystitis glandularis treated from December 2006 to August 2017 were collected.Age of 49 patients was (34.4 ±7.5) years old and BMI was (21.9 ± 4.2) kg/m2.There were 19 cases of hypertension and 18 cases of diabetes.According to the cystoscopic manifestations,follicular edema type,papilloma type,and intestinal adenomatosis type were defined as high risk.Chronic inflammatory type and mucosa unchanged type were defined as low risk.Immunohistochemical staining was used to detect tissue samples,to compare the general data of different types of cystitis glandularis and the degree of infiltration of bladder mucosal inflammatory cells.Results T lymphocytes were highly expressed in 10 patients,and B lymphocytes and plasma cells were not expressed or extremely low (P ＜ 0.01).Of the 49 patients,29 were high risk type cystitis glandularis (follicular edema type,papilloma type,and intestinal adenomatosis type),and 21 were low risk type (chronic inflammatory type and mucosa unchanged type).The age of the high-risk group was (34.4 ± 7.5) years old with BMI of (21.9 ±4.2) kg/m2,8 cases of hypertension and 8 cases of diabetes.The age of the low-risk group was (38.2 ±8.5) years old with BMI of (20.8 ±4.0) kg/m2,11 cases of hypertension and 10 cases of diabetes.There was no statistically significant difference between two groups (P ＞ 0.05).The OABSS of high-risk group(10.4 ± 2.6) was significantly higher than that of low-risk group (7.1 ± 2.1,P ＜ 0.01).QOL of high-risk group (4.9 ± 0.9) was significantly higher than that of low-risk group (4.1 ± 0.8,P ＜ 0.01).Qmax of high-risk group was (11.4 ± 3.6) ml/s,significantly lower than that of low-risk group[(15.8 ±3.8) ml/s,P ＜0.01].The positive number of T lymphocytes of high-risk group was (173.5 ± 26.8),which was significantly higher than that of low-risk group(119.5 ± 21.2,P ＜ 0.01).Conclusions T lymphocytes infiltration is the major phenomenon in bladder submucosa of female patients with cystitis glandularis.The inflammatory infiltration by T lymphocytes could be associated with patient's symptom and bladder's pathological changes.

Objective To compare the long-term outcomes of the retropubic tension-free vaginal tape (TVT) versus the transobturator tension-free vaginal tape (TVT-O) for women with stress urinary incontinence (SUI).Methods From July 2001 to June 2011,data of 120 female patients with SUI were retrospectively reviewed,of which 45 patients received TVT treatment,while 75 patients received TVT-O.The median age in TVT group was 45.1 years (range 35-72 years),and the median age in TVT-O group was 50.5 years (range 39-76 years).We retrospectively analyzed the long-term subjective effect,objective effect and the rate of complications in the two groups.Results Median follow-up period was 121 months (range 72-192 months).The complete satisfaction rate was 89％ (40/45) in TVT group,and 92％(69/75) in TVT-O group,with no statistical difference between the two groups.The negative rate of cough test was 84.4％ (38/45) in TVT group,and 76.0％ (57/75)in TVT-O group,with a statistically significant difference.The rate of urinary tract injury was 8.9％ (4/45) in TVT group,and 4.0％ (3/75) in TVT-O group.The rate of thigh pain was 0 in TVT group,and 6.7％ (3/45) in TVT-O group.The rate of micturition frequency and urinary incomplete emptying after operations was 6.7％ (5/75) in TVT group,and 5.3％ (4/75) in TVT-O group.Conclusions The long-term subjective effect between TVT and TVT-O groups was similar.The objective effect in TVT group was better.There was no statistical difference in complication rate between the two groups,which showed different types of complications in different procedures.