Résumé
OBJECTIVE To explore the material basis and mechanism of expectorant and cough relief effects of the fruits of Phellodendron chinense var. glabriusulum Schneid. METHODS The expectorant and cough relief effects of volatile oil and water decoction of the fruits of P. chinense var. glabriusulum Schneid. were studied by ammonia water cough induction and drug expectorant model mice experiments； GC-MS and UPLC-MS technologies were used to identify its volatile oils and non-volatile components of the fruits of P. chinense var. glabriusulum Schneid. The active ingredients， core targets and pathways of expectoration and cough relief were analyzed by network pharmacology. RESULTS The volatile oil （0.8， 0.2 g/kg， calculated by volatile oil） and water decoction （12， 3 g/kg， calculated by crude drug） of the fruits of P. chinense var. glabriusulum Schneid. both had obvious expectorant and cough relief effects， and showed obvious dose-dependent relationship. A total of 38 volatile oil components were identified from the medicinal herbs， and the relative percentage contents of 8 components were greater than 1%， such as α -pinene， myrcene， β -caryophyllene， germanene D， isospathulenol； a total of 69 non-volatile oil components were identified， mainly including phenolic compounds， alkaloids， and flavonoids. The active ingredients screened from the identified components included 13 compounds such as α-pinene， myrcene， chlorogenic acid， luteolin， berberine. There were a total of 55 intersection targets with diseases， and the core targets were tumor necrosis factor （TNF）， epidermal growth factor receptor （EGFR）， vascular endothelial growth factor A （VEGFA）， serine/threonine kinase proteins （AKT1） and Toll-like receptor 4 （TLR4）. The molecular docking results showed that the active ingredients and the core targets had good binding ability. GO functional analysis found that the targets were significantly enriched in biological processes such as the reaction affecting lipopolysaccharides， the positive regulation of peptidyl serine phosphorylation， and the positive regulation of the biosynthesis process of nitric oxide. KEGG pathway enrichment analysis found that the targets were significantly enriched in the signaling pathways such as cancer， non-small cell lung cancer， proteoglycans in cancer. CONCLUSIONS Fruits of P. chinense var. glabriusulum Schneid. have obvious expectorant and cough relief effects， and its material basis may be α-pinene， myrcene， chlorogenic acid， luteolin， berberine， etc.， and mainly act on TNF， EGFR， VEGFA， AKT1， TLR4 and its significantly enriched signaling pathway.
Résumé
Objective:To explore the clinical characteristics of superficial neoplasia associated with submucosal tumor (SMT) located at the same position and the efficacy of endoscopic super minimally invasive surgery (SMIS).Methods:Data of 9 patients who were diagnosed as having superficial neoplasia associated with SMT at the same position in the upper digestive tract and treated with digestive endoscopic SMIS at the First Medical Center of PLA General Hospital from January 2011 to December 2021 were retrospectively analyzed. Data including basic information, endoscopic diagnosis and treatment, pathological results and follow-up of these patients were collected to analyze their clinicopathological characteristics. The postoperative pathology and incidence of complications were used as the gold standard to assess the effectiveness and safety of SMIS.Results:In the 9 patients, there were 8 males and 1 female with mean age of 61.6±11.7 years. The main symptoms were abdominal pain in 3 cases, abdominal discomfort in 2 cases, and dysphagia in 1 case. Seven patients were diagnosed as having superficial neoplasia before surgery, while SMT was found during surgery. One patient with superficial neoplasia associated with SMT and 1 with SMT were diagnosed before the surgery. The common sites of the lesion were esophagus (3 cases), gastric antrum (3 cases), cardia (2 cases) and fundus (1 case). The Paris classification of all lesions was type Ⅰ, Ⅱa or combinations. The most common pathological type was early cancer with leiomyoma in 5 cases. All lesions met the criteria of en bloc resection. One lesion had positive lateral margin with low-grade intraepithelial neoplasia, four were all completely resected. No complications such as bleeding, perforation or infection occurred in this study. Follow-up date were available in all cases with a mean period of 19-81 months and no recurrence or metastasis was discovered.Conclusion:The symptoms of patients with superficial neoplasia associated with SMT located at the same position are often atypical. The endoscopic type of lesions is usually protrusion or partial protrusion. Most are diagnosed as having superficial neoplasia before the surgery, and SMT are usually found coincidentally. The most common pathological type is early cancer with leiomyoma. SMIS is safe and effective for the complex lesion.