Polycystic ovarian syndrome （PCOS） is a common endocrine and metabolic disease mainly occurring among women of childbearing age. Its main symptoms include menstrual disorders， acne， hirsutism， infertility， oily skin， acanthosis nigricans， and obesity. Currently， the etiology and pathogenesis of PCOS remain unclear. Classical formulas， which have rigorous compatibility， concise composition， precise alignment with syndromes， and definitive therapeutic effects， demonstrate unique practical and scientific value in the treatment of PCOS. These formulas exhibit significant clinical efficacy， mild adverse effects， and sustained therapeutic outcomes. To explore the current status and mechanisms of classical formulas in treating PCOS， on the basis of Zhang Zhongjing's academic thoughts on gynecological diseases， this paper reviewed the relevant literature on the treatment of PCOS with classical formulas in recent years. The findings reveal that the pathogenesis of PCOS predominantly involves a combination of internal deficiency and superficial excess， closely related to dysfunction of the liver， spleen， and kidney. The root cause lies in deficiency， and on this basis， there are also symptoms of qi stagnation， blood stasis， phlegm obstruction， and dampness encumbrance. Commonly used classical formulas for treating this disease include Guizhi Fuling pills， Danggui Shaoyao powder， Wenjing decoction， and Jingui Shenqi pills. These classical formulas have good clinical efficacy in treating PCOS. Their mechanisms of action may be related to improving serum levels of sex hormones， increasing the dominant follicle diameter and endometrial thickness， alleviating insulin resistance， lowering glucose and lipid metabolism， inhibiting oxidative and inflammatory reactions in the ovarian tissue， regulating the intestinal flora， correcting the flora disorder， protecting the intestinal barrier function， and regulating the phosphatidylinositol 3-kinase/protein kinase B signaling pathway. The above research results can help doctors use classical formulas flexibly， broaden diagnostic and therapeutic approaches for PCOS and provide ideas for improving the traditional Chinese medicine diagnosis and treatment plan for PCOS.

Polycystic ovarian syndrome （PCOS） is a common endocrine and metabolic disease mainly occurring among women of childbearing age. Its main symptoms include menstrual disorders， acne， hirsutism， infertility， oily skin， acanthosis nigricans， and obesity. Currently， the etiology and pathogenesis of PCOS remain unclear. Classical formulas， which have rigorous compatibility， concise composition， precise alignment with syndromes， and definitive therapeutic effects， demonstrate unique practical and scientific value in the treatment of PCOS. These formulas exhibit significant clinical efficacy， mild adverse effects， and sustained therapeutic outcomes. To explore the current status and mechanisms of classical formulas in treating PCOS， on the basis of Zhang Zhongjing's academic thoughts on gynecological diseases， this paper reviewed the relevant literature on the treatment of PCOS with classical formulas in recent years. The findings reveal that the pathogenesis of PCOS predominantly involves a combination of internal deficiency and superficial excess， closely related to dysfunction of the liver， spleen， and kidney. The root cause lies in deficiency， and on this basis， there are also symptoms of qi stagnation， blood stasis， phlegm obstruction， and dampness encumbrance. Commonly used classical formulas for treating this disease include Guizhi Fuling pills， Danggui Shaoyao powder， Wenjing decoction， and Jingui Shenqi pills. These classical formulas have good clinical efficacy in treating PCOS. Their mechanisms of action may be related to improving serum levels of sex hormones， increasing the dominant follicle diameter and endometrial thickness， alleviating insulin resistance， lowering glucose and lipid metabolism， inhibiting oxidative and inflammatory reactions in the ovarian tissue， regulating the intestinal flora， correcting the flora disorder， protecting the intestinal barrier function， and regulating the phosphatidylinositol 3-kinase/protein kinase B signaling pathway. The above research results can help doctors use classical formulas flexibly， broaden diagnostic and therapeutic approaches for PCOS and provide ideas for improving the traditional Chinese medicine diagnosis and treatment plan for PCOS.

Objective:To explore the difference between selective lobar bronchial block and main bronchial block in thoracoscopic surgery in children.Methods:A retrospective cohort study was conducted to analyze the clinical data of 150 children undergoing thoracoscopic surgery admitted to Henan Children's Hospital, Zhengzhou Children's Hospital, and Children's Hospital Affiliated to Zhengzhou University from December 2019 to December 2022. In the examination of the electronic medical record, 80 children were found to have selective lobar bronchial block, which was used as the study group, and 70 children were matched as the control group.Compare the general data of children in the two groups, such as age, gender, weight, surgical time, and other data. Compare the two groups with respect to hypoxemia, degree of pulmonary collapse, atelectasis, and number of bronchial blocker shifts. Compare the heart rate(HR), mean arterial pressure(MAP), degree of pulmonary collapse, and airway pressure(PAW) at different time points in the two groups[before single lung ventilation(OLV)(T1), 10 min after OLV(T2), and 10 min after OLV(T3)] Difference in alveolar arterial oxygen partial pressure(AaDO 2) levels. Results:Comparison of the incidence of hypoxemia, bronchial blocker displacement, and atelectasis in children in the study group were statistically significant( P<0.05). The results of repeated measurement of variance showed that there was statistically significant difference in the inter subject effects of HR and MAP levels at different time points between the two groups based on time factors( P<0.05). The results of repeated measurement of variance showed that there was statistical significance between the inter-subjective effects of the levels of PAW and AaDO 2 at different time points of the two groups with time factor as the source, group as the source, and intra-subjective effects with time and group interaction as the source( P<0.05). The levels of PAW and AaDO 2 in the study group at time points T2 and T3 were significantly lower than those in the control group, and the differences between the groups were statistically significant( P<0.05). Conclusion:The effect of selective lobobronchial blockade in thoracoscopic surgery in children is ideal, which can effectively improve the ventilation and related oxygenation of children, and reduce the occurrence of complications such as atelectasis and hypoxemia.

Pyrrole [1,2-α] indole is a novel fused heterocyclic skeleton, which is also the basic structural unit and synthetic intermediate of many natural active products and drugs. Pyrrole [1,2-α] indole heterocyclic derivatives have attracted much attention in organic synthesis and medicinal chemistry because of their extensive and marked biological activities. Plant extracts have always been an important source of active compounds. At present, the alkaloids based on the pyrrole [1,2-α] indole heterocyclic structure discovered and isolated from plant extracts include isatisine, isoborreverine, flinderoles, polyavolensin and yuremamine. This paper reviews the research progress on the biological activity of pyrrole [1,2-α] indole heterocyclic derivatives and has found that pyrrole [1,2-α] indole heterocyclic derivatives have a good development prospect in screening active compounds and developing candidate drugs.

Background::Gut-resident macrophages (gMacs) supplemented by monocytes-to-gMacs differentiation play a critical role in maintaining intestinal homeostasis. Activating transcription factor 4 (ATF4) is involved in immune cell differentiation. We therefore set out to investigate the role of ATF4-regulated monocytes-to-gMacs differentiation in sepsis-induced intestinal injury.Methods::Sepsis was induced in C57BL/6 wild type (WT) mice and Atf4-knockdown ( Atf4+/-) mice by cecal ligation and puncture or administration of lipopolysaccharide (LPS). Colon, peripheral blood mononuclear cells, sera, lung, liver, and mesenteric lymph nodes were collected for flow cytometry, hematoxylin and eosin staining, immunohistochemistry, quantitative reverse transcription polymerase chain reaction, and enzyme-linked immunosorbent assay, respectively. Results::CD64, CD11b, Ly6C, major histocompatibility complex-II (MHC-II), CX3CR1, Ly6G, and SSC were identified as optimal primary markers for detecting the process of monocytes-to-gMacs differentiation in the colon of WT mice. Monocytes-to-gMacs differentiation was impaired in the colon during sepsis and was associated with decreased expression of ATF4 in P1 (Ly6C hi monocytes), the precursor cells of gMacs. Atf4 knockdown exacerbated the impairment of monocytes-to-gMacs differentiation in response to LPS, resulting in a significant reduction of gMacs in the colon. Furthermore, compared with WT mice, Atf4+/- mice exhibited higher pathology scores, increased expression of inflammatory factor genes ( TNF-α, IL-1β), suppressed expression of CD31 and vascular endothelial-cadherin in the colon, and increased translocation of intestinal bacteria to lymph nodes and lungs following exposure to LPS. However, the aggravation of sepsis-induced intestinal injury resulting from Atf4 knockdown was not caused by the enhanced inflammatory effect of Ly6C hi monocytes and gMacs. Conclusion::ATF4, as a novel regulator of monocytes-to-gMacs differentiation, plays a critical role in protecting mice against sepsis-induced intestinal injury, suggesting that ATF4 might be a potential therapeutic target for sepsis treatment.

Objective: To investigate the clinical research of Guo's Liulian therapy in treating acute pancreatitis intestinal mucosal barrier dysfunction and provide reference for the patients with acute pancreatitis. Methods: The 68 patients with acute pancreatitis who were admitted to our hospital from September 2016 to May 2018 were selected as study subjects. According to the random number table method, the patients were divided into the observation group and the control group, with 34 cases in each group. The patients in the control group were treated with conventional western medicine. The patients in the observation group were treated with Guo's Liulian therapy on the basis of the above treatment. The time of intestinal paralysis was compared between the two groups. The changes of intestinal mucosal barrier function and serum inflammatory factor related indexes before and after treatment were analyzed in the two groups. The difference of therapeutic effects between the two groups was observed. Results: In the observation group, the abdominal pain relief time, abdominal distention relief time, bowel sound recovery time, and first bowel anus defecation time were significantly lower than those in the control group (t=7.621, 5.332 6.625, 8.762, all Ps<0.01). After treatment, serum LPS, DAO, ET, D-lactic acid, TNF-α, IL-1, IL-6, IL-8, and IL-10 and urine L/M were significantly lower in the observation group, while the serum ITF and MFG-E8 were significantly higher in the observation group (t=9.856, 6.974, 9.784, 16.068, 9.550, 12.506, 22.343, 16.625, 6.774, 23.469, 20.118, 23.031, all Ps<0.01). Conclusions The Guo's Liulian therapy treatment of acute pancreatitis in patients with intestinal mucosal barrier dysfunction can reduce the palsy remission time, reduce inflammation, increase serum ITF, MFG-E8 levels, repair of intestinal permeability, and improve the intestinal barrier function.

Objective To investigate the clinical efficacy of laparoscopic anatomical left hepatectomy by guided middle hepatic vein approach.Methods The clinical data of 21 patients undergone anatomical left hepatectomy from Oct.2015 to Jul.2018 were retrospectively analyzed.Results Among the 21 cases,the primary hepatocellular carcinoma were found in 4 patients (19.1％),the cholangiocarcinoma in 1 patients (4.8％),the giant hepatic hemangioma in 1 patients (4.8％),the hepatolithiasis in 15 patients (71.3％).All 21 patients were operated under laparoscopy and recovered.The operative time was 160-380 min,the average operative time was(248 ± 56)min,the intraoperative blood loss was 100-700 ml.The average blood loss was (250 ± 40)ml,the average length of hospital stay of the patients was 8-14 (10 ± 2)d.Conclusions Laparoscopic anatomical left hepatectomy guided by middle hepatic vein approach is a safe and effective operation.

Objective:To investigate the clinic effect of r-MHT and hematoma aspiration on the traumatic intracerebral hematoma.Methods:89 cases with traumatic intracerebral hematoma were given hematoma aspiration,47 of them were given r-MHT and hematoma aspiration,the clinic effect on the 1st,7th,14th day after treatment were evaluated by NIHSS,the hematoma volume before treatment on the 1st,7th,14th day after treatment were counted by Dotian formula.Results:The effective rate of treatment group was 93.6％,which was significantly higher than that of the control group (P＜0.05).The NIHSS score of treatment group was significantly higher than that of the control group(P＜0.05) on the 1 st day,1st,2nd week after treatment (P＜0.05).Conclusion:r-MHT and hematoma aspiration couldn effectively reduce the brain damage,improve the patient's neurological fumction in treating traumatic intracerebral hematoma.

BACKGROUND:Activation of Notch signaling plays a critical role in stem cel differentiation, and this effect seems to be cel-type dependent. Little is reported on the role of activation of Notch1 signaling in the differentiation of c-Kit+ bone marrow mesenchymal stem cels. OBJECTIVE:To analyze the influence of activation of Notch1 signaling on the differentiation of c-Kit+ bone marrow mesenchymal stem cels. METHODS:The Notch1 intracelular domain (N1-ICD) was obtained from the cDNA library by PCR and cloned intoBamHI/AgeI digested adenoviral GV314 plasmid to construct N1-ICD overexpressing shuttle plasmid, and the positive clones were verified by sequencing. N1-ICD shuttle plasmid and helper plasmids pBHGloxΔE1,3 Cre were used to co-transfect HEK293T cels to obtain N1-ICD overexpressing adenoviral particles (N1-ICD-Ad). The c-Kit+ subpopulation were isolated from bone marrow mesenchymal stem cels of the Sprague-Dawley rat femurviamagnetic activated cel sorting. After transfection of the c-Kit+ BMSCs with N1-ICD-Ad adenovirus, we assessed the activation of Notch1 signaling and differentiation in c-Kit+ bone marrow mesenchymal stem cels by quantitative RT-PCR and immunofluorescent staining. RESULTS AND CONCLUSION:N1-ICD coding sequence was successfuly generated from the cDNA library, and then was cloned into the linearized adenoviral vectors GV314. The resistant clones were verified by sequencing. With the assistance of packaging plasmids, recombinant N1-ICD-Ad adenovirus plasmids were successful packaged in HEK293T cels, and its title was 2×1012 PFU/L. c-Kit+ bone marrow mesenchymal stem cels with the purity of 91.6% were successfuly isolated from the bone marrow mesenchymal stem cels of the Sprague-Dawley rat femur. Compared with the blank and negative controls, N1-ICD-Ad infection in the c-Kit+ bone marrow mesenchymal stem cels led to substantial accumulation of N1-ICD in the cytoplasm and nuclei, significantly unregulated expressions of Hes1 (a downstream gene of Notch) and cardiomyocyte differentiation genes Nkx2.5 and cTnT, significantly increased the expression of von Wilebrand factor, an endothelial cel differentiation gene, and mildly increased the expression of smooth muscle22α, a smooth muscle cel differentiation gene. These experimental results indicate that the activation of Notch1 signaling contributes to multi-lineages differentiation of c-Kit+ bone marrow mesenchymal stem cels, and the construction of N1-ICD overexpressing adenoviral vector makes the foundation for further research on the role of Notch1 signaling in stem cel biology.

Objective To compare the efficacy of arterial stenting with that of traditional B -T shunt for neo-natal pulmonary atresia with intact ventricular septum.Methods Twenty -six cases of neonatal pulmonary atresia with intact ventricular septum were treated at Children′s Hospital of Zhengzhou from December 2005 to December 201 5,aged 3 to 23 days[(8.20 ±4.80)days],and weighted 2.80 -3.88 (3.41 ±0.27)kg.Accompanied with pulmonary hypo-plasia,all these patients were combined with PDA and ASD or PFO.Before operation,the peripheral oxygen saturation was kept in 61 % -75%,averaged at 67%.Among them,1 2 cases underwent arterial catheter stenting,and 1 4 cases re-ceived B -T shunt (including modified B -T shunt and central shunt)ductus ligation.After operation,the oxygen satu-ration in these children was observed,and they were examined by echocardiography and true lateral chest X -ray,blood flow situations in stents and shunts were assessed,and follow -up examinations were conducted in 1 ,3,6 and 1 2 months postoperatively.Results Stents were successfully inserted into these 1 2 cases.After traditional pulmonary shunt,pa-tients′peripheral oxygen saturation was (82.73 ±5.59)%,compared with that of patients after arterial catheter sten-ting (86.1 8 ±3.1 9)%,there was significant difference(t =1 0.71 ,P <0.05).In pulmonary shunt group,2 cases died,1 case died of postoperative heart failure,and the other case was complicated with pulmonary infection and died of respiratory failure;in catheter stent group,1 case was complicated with postoperative supraventricular tachycardia and recovered after drug intervention.For the follow -up examinations 1 ,3,6 and 1 2 months after the operation,1 case of B -T shunt in pulmonary shunt group was improved by central shunt due to slow blood flow,less shunt volume,and ox-ygen saturation decreased to 69%.For the catheter stent group,1 case was improved by stent balloon dilatation due to declined peripheral oxygen saturation 2 months postoperatively,and after the operation,transcutaneous oxygen saturation was improved.No patients died in the catheter stent group.Conclusions In traditional B -T shunts,the operation is extensive,and complications are common,and the recovery turns slowly.Arterial catheter stenting can be used as the preferred method of treatment for one -stage surgical pulmonary atresia with intact ventricular septum to reduce the weakness feasibly and effectively.