OBJECTIVE To investigate the effects and mechanism of the Yishen paidu formula on renal fibrosis in rats with chronic renal failure （CRF） through the reactive oxygen species （ROS）/thioredoxin-interacting protein （TXNIP）/NOD-like receptor thermal protein domain associated protein 3 （NLRP3） pathway. METHODS Rats were randomly divided into control group， model group， Yishen paidu formula low-dose （Yishen paidu formula-L） group， Yishen paidu formula high-dose （Yishen paidu formula- H） group， Yishen paidu formula-H+pcDNA-NC group， and Yishen paidu formula-H+ pcDNA-TXNIP group， with 10 rats in each group. Except for control group， all other rats were fed a diet containing 0.5% adenine to establish a CRF model； the rats were then administered corresponding drugs or normal saline intragastrically or via tail vein， once daily， for 8 consecutive weeks. After the last administration， the levels of serum creatinine （Scr）， blood urea nitrogen （BUN）， ROS， superoxide dismutase （SOD）， malondialdehyde （MDA）， tumor necrosis factor-α （TNF-α）， interleukin （IL）-6， and IL-1β were measured in each group. Pathological changes in renal tissue were observed， and the protein expression levels of Collagen Ⅲ， α-smooth muscle actin （α-SMA）， transforming growth factor-β1 （TGF-β1）， TXNIP and NLRP3 in renal tissue were detected. RESULTS Compared with model group， the renal histopathological damage and fibrosis of rats in Yishen paidu formula-L group and Yishen paidu formula-H group were significantly alleviated. The levels of Scr， BUN， ROS， MDA， TNF- α， IL-6 and IL-1β， and the protein expressions of Collagen Ⅲ， α-SMA， TGF-β1， TXNIP and NLRP3 were significantly decreased， while SOD levels were significantly increased （P＜0.05）. Moreover， the changes were more pronounced in the Yishen paidu formula-H group （P＜0.05）. Compared with Yishen paidu formula-H+pcDNA-NC group， above indexes of rats in Yishen paidu formula-H+pcDNA-TXNIP group were reversed significantly （P＜0.05）. CONCLUSIONS Yishen paidu formula can inhibit renal fibrosis in CRF rats by suppressing the ROS/TXNIP/NLRP3 pathway.

ObjectiveTo investigate the association between immunoglobulin G （IgG）/immunoglobulin M （IgM） ratio and prognosis in patients with initially unresectable hepatocellular carcinoma （iuHCC） receiving TTP triple therapy with transcatheter arterial chemoembolization （TACE）， tyrosine kinase inhibitor （TKI）， and programmed cell death protein-1 （PD-1） inhibitors. MethodsA retrospective analysis was performed for the clinical data of 151 iuHCC patients who received TTP triple therapy in Department of Hepatobiliary Surgery， Guangxi Medical University Cancer Hospital， from November 2019 to December 2022， and according to IgG/IgM ratio， they were divided into high IgG/IgM group （IgG/IgM ratio >13.23） and low IgG/IgM group （IgG/IgM ratio ≤13.23）. The t-test was used for comparison of continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method and the log-rank test were used for survival analysis， and the Cox proportional hazards model was used to investigate the potential influencing factors for overall survival （OS）. ResultsThe 151 patients had a median OS of 26.7 months （95% confidence interval ［CI］： 19.8-not reached） and a median progression-free survival of 12.5 months （95%CI： 10.4 — 15.8）. The objective response rate was 83.4% and the disease control rate was 94.0%. There were no significant differences in baseline data between the high IgG/IgM group and the low IgG/IgM group （all P>0.05）. There was a significant difference in median OS between the high IgG/IgM group and the low IgG/IgM group （20.6 months vs not reached， P=0.016）. In both the high IgG/IgM group and the low IgG/IgM group， salvage hepatectomy was significantly associated with the improvement in OS （χ²=8.297 and 10.307， both P<0.05）. The multivariate analysis showed that high IgG/IgM ratio （hazard ratio ［HR］=1.799， 95%CI： 1.077 — 3.006， P=0.025）， baseline alpha-fetoprotein >400 ng/mL （HR=1.762， 95%CI： 1.017 — 3.050， P=0.043）， and BCLC stage （HR=2.265， 95%CI： 1.212 — 4.232， P=0.010） were independent influencing factors for OS. ConclusionHigh IgG/IgM ratio is associated with a poorer prognosis in iuHCC patients receiving TTP triple therapy， and salvage hepatectomy has a potential value in improving the prognosis of patients with a high IgG/IGM ratio.

Objective To investigate the relationship between the levels of C1q/tumor necrosis factor-relat-ed protein 9(CTRP9),Klotho(Klotho)and chitinase 1(CHIT1)in aqueous humor with the disease severity and macular edema(ME)in patients with retinal vein occlusion(RVO).Methods A total of 174 in patients with ME caused by RVO who visited the hospital from January 2022 to June 2024(observation group)and 174 patients with simple RVO(RVO group)were selected.Observation group was divided into mild,moder-ate and severe subgroup according to the disease severity of ME.The levels of CTRP9,Klotho and CHIT1 in aqueous humor between RVO group and observation group were compared.The evaluation value of CTRP9,Klotho and CHIT1 levels in aqueous humor for ME in patients with RVO was analyzed by receiver operating characteristic(ROC)curve.The influencing factors of ME in patients with RVO were analyzed by univariate and multivariate Logistic regression model.The correlation between the levels of CTRP9,Klotho,CHIT1 in a-queous humor with the disease severity of ME in patients with RVO was analyzed by spearman correlation a-nalysis.Results Compared with RVO group,the levels of CTRP9 and Klotho in aqueous humor of observa-tion group were lower,and the level of CHIT1 was higher(P＜0.05).ROC analysis curve showed that,the area under the curve(AUC)of CTRP9,Klotho and CHIT1 in aqueous humor for evaluating ME in patients with RVOwere 0.757,0.773 and 0.813,respectively.The AUC of combined detection of the three was 0.939,and the efficiency of combined evaluation was higher than that of the single evaluation(Z=7.520,7.513,6.278,all P＜0.05).Multivariate Logistic regression model showed that high level of CHIT1 in aque-ous humor,hypertension and severe retinal vein tortuosity were risk factors for ME in patients with RVO(P＜0.05),and high levels of CTRP9 and Klotho in aqueous humor were protective factors(P＜0.05).Spearman correlation analysis showed that the levels of CTRP9 and Klotho in aqueous humor were negatively correlated with the disease severity of ME in patients with RVO(r=-0.584,-0.401,all P＜0.05),while level of CHIT1 in aqueous humor was positively correlated with the disease severity of ME in patients with RVO(r=0.809,P＜0.05).Conclusion The levels of CTRP9,Klotho and CHIT1 in aqueous humor have high value in the evaluation of ME in patients with RVO,and they are the influencing factors of ME in pa-tients with RVO.The level changes of the three are closely related to the disease severity of ME in patients with RVO.

Objective:To compare the efficacy and safety of Rotarex mechanical thrombectomy (Rotarex) combined with drug-coated balloon (DCB) versus percutaneous transluminal angioplasty (PTA) combined with DCB in the treatment of femoropopliteal artery in-stent restenosis (ISR).Methods:A multicenter, prospective, randomized controlled trial was conducted. 46 patients with femoropopliteal artery ISR admitted to five hospitals (Beijing Friendship Hospital, Capital Medical University; Beijing Chaoyang Hospital, Capital Medical University; Beijing Jishuitan Hospital, Capital Medical University; Xuanwu Hospital, Capital Medical University; Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University) from July 2020 to June 2024 were enrolled. Patients were randomly divided into the Rotarex+ DCB group ( n=24) and the PTA+ DCB group ( n=22) using a random number table. The clinical data of the two groups were collected, including clinical characteristics, Fontaine classification, stent placement location, stent duration, and lesion length. The primary endpoint was the target blood vessel patency rate at 6 and 12 months postoperatively; the secondary endpoints included improvement in clinical symptoms (Fontaine classification), rate of reintervention, and safety indicators. Measurement data were expressed as mean±standard deviation ( ± s), and the t-test was used for comparison between groups; count data were expressed as the number of cases and percentages, and intergroup comparisons were performed using the Chi-test or Fisher exact probability method. Results:At 12 months postoperatively, the target blood vessel patency rate in the Rotarex+ DCB group was significantly higher than that in the PTA+ DCB group (81.8% vs 45.5%, P=0.012), and the proportion of patients in Fontaine classification stage I was also higher (86.4% vs 45.5%, P=0.004). The results at the 6-month follow-up were consistent (target blood vessel patency rate: 87.0% vs 59.1%, P=0.035). In terms of safety, no severe complications such as arterial rupture, amputation, or procedure-related death occurred during the perioperative period in either group. During the postoperative follow-up, no amputation or procedure-related deaths occurred in either group. Conclusion:For the treatment of femoropopliteal artery ISR, Rotarex mechanical thrombectomy combined with DCB is significantly superior to PTA+ DCB in terms of 12-month target blood vessel patency rate and improvement of clinical symptoms, with comparable safety.

Objective:To construct a predictive model of ≥ grade 2 radiation esophagitis (RE) in patients with esophageal cancer during concurrent radiochemotherapy (CRT) based on machine learning (ML) algorithm.Methods:A retrospective analysis was conducted on the clinical data of 276 patients with esophageal cancer who had received CRT at Lu'an Hospital of Anhui Medical University from January 2018 to January 2023. The occurrence of RE was evaluated according to grading criteria of RE developed by American Radiation Therapy Oncology Group, with ≥ grade 2 RE as the outcome event. After screening variables through the least absolute shrinkage and selection operator (LASSO) regression, the dataset was re-established. The dataset was then divided into training set ( n=193) and testing set ( n=83) in a 7∶3 ratio and included in four ML models: random forest (RF) , decision tree (DT) , extreme gradient boosting (XGBoost) , and support vector machine (SVM) . In the models, data training and model optimization were conducted in the training set, and model performance was evaluated in the testing set using the receiver operator characteristic (ROC) curve. The area under the curve (AUC) , accuracy, precision, sensitivity, and F1 score were calculated to assess the model. SHAP analysis was used to explain the optimal model. Results:By the end of follow-up, 91 cases (32.97%) of esophageal cancer patients had experienced ≥ grade 2 RE during CRT. There were statistically significant differences in tumor lesion length ( Z=-5.53, P<0.001) , Karnofsky performance status (KPS) score ( χ2=5.92, P=0.015) , the Eastern Cooperative Oncology Group (ECOG) score ( χ2=4.01, P=0.045) , hypertension ( χ2=15.35, P<0.001) , diabetes ( χ2=13.06, P<0.001) , white blood cell count ( Z=-6.59, P<0.001) , neutrophil count ( Z=-6.72, P<0.001) , and radiotherapy dose ( χ2=9.81, P=0.002) between ≥ grade 2 RE occurrence group ( n=91) and no occurrence group ( n=185) . After LASSO regression screening, 7 characteristic variables were ultimately selected, which were tumor lesion length, ECOG score, KPS score, neutrophil count, hypertension, diabetes, and radiotherapy dose. ROC curve analysis showed that the XGBoost model had better predictive performance, with an AUC of 0.90, accuracy of 0.82, precision of 0.80, sensitivity of 0.73, and F1 score of 0.76. The AUC, accuracy, precision, sensitivity, and F1 score of RF model were 0.89, 0.78, 0.76, 0.48, and 0.59, respectively. The AUC, accuracy, precision, sensitivity, and F1 score of DT model were 0.72, 0.72, 0.44, 0.60, and 0.52, respectively. The AUC of SVM model was 0.74, with an accuracy of 0.82, precision of 0.52, sensitivity of 0.88, and F1 score of 0.65. The XGBoost model was explained using SHAP analysis, which indicated that the tumor lesion length, neutrophil count, hypertension, diabetes, and radiotherapy dose had a strong predictive ability for the occurrence of ≥ grade 2 RE during CRT in esophageal cancer patients. Conclusions:The model established based on the XGBoost method has good predictive performance for the occurrence of ≥ grade 2 RE in esophageal cancer patients during CRT. Meanwhile, combined with SHAP analysis, it can provide an intuitive understanding of the impact of important features in the model on the outcome.

Objective:To explore the medication law for threatened irritability in ancient gynecological monographs based on data mining.Methods:Based on Zhong Hua Yi Dian (5th edition), Chinese Medicine Resource Network and the paper version of ancient books, the representative gynecological monographs from the pre-Qin to the Qing Dynasty were selected to retrieve the prescriptions for the treatment of fetal irritability and establish a database. Excel 2019, IBM SPSS Modeler 18.0 and IBM SPSS Statistics 26.0 software were used to perform frequency statistics, association rule analysis and clustering analysis on the data of Chinese materia medica, analyze the core drug groups, and explore the medication laws. Results:A total of 151 prescriptions were included, including 7 kinds of TCM syndrome types, involving 111 kinds of Chinese materia medica. The most commonly used Chinese materia medica were Angelicae Sinensis Radix, Glycyrrhizae Radix et Rhizoma, Atractylodis Macrocephalae Rhizoma, Chuanxiong Rhizoma, and Paeoniae Radix Alba, etc. The efficacy categories were mainly tonic, heat-clearing, blood-activating and stasis-resolving; the medicinal properties were mainly warm and neutral; the tastes were mainly sweet and pungent; the main meridians were spleen, lung, liver and kidney meridians. 17 commonly used TCM combinations were obtained by association rule analysis, and five core TCM combinations were obtained by clustering analysis.Conclusions:In the treatment of threatened irritability, ancient doctors used the method of tonifying kidney and invigorating spleen, tonifying qi and nourishing blood, clearing heat and preventing miscarriage flexibly. The core drugs were mainly Angelicae Sinensis Radix, which was mostly modified on the basic prescriptions such as Siwu Decoction and Jiaoai Decoction.

Traditional Chinese medicine (TCM) is a well-accepted therapy for atopic dermatitis (AD). However, there are currently no evidence-based guidelines integrating TCM and Western medicine for the treatment of AD, limiting the clinical application of such combined approaches. Therefore, the China Association of Chinese Medicine initiated the development of the current guideline, focusing on key issues related to the use of TCM in the treatment of AD. This guideline was developed in accordance with the principles of the guideline formulation manual published by the World Health Organization. A comprehensive review of the literature on the combined use of TCM and Western medicine to treat AD was conducted. The findings were extensively discussed by experts in dermatology and pharmacy with expertise in both TCM and Western medicine. This guideline comprises 23 recommendations across seven major areas, including TCM syndrome differentiation and classification of AD, principles and application scenarios of TCM combined with Western medicine for treating AD, outcome indicators for evaluating clinical efficacy of AD treatment, integration of TCM pattern classification and Western medicine across disease stages, daily management of AD, the use of internal TCM therapies and proprietary Chinese medicines, and TCM external treatments. Please cite this article as: Du XR, Wu MY, Tao MC, Lin Y, Gu CY, Wu MF, Cao Y, Chen DC, Li W, Wang HW, Wang Y, Wang Y, Lu HZ, Liu X, Su XF, Li FL. Clinical practice guidelines for the diagnosis and treatment of atopic dermatitis with integrative traditional Chinese and Western medicine. J Integr Med. 2025; 23(6):641-653.
Dermatitis, Atopic/drug therapy* ; Humans ; Medicine, Chinese Traditional/methods* ; Integrative Medicine ; Drugs, Chinese Herbal/therapeutic use* ; Practice Guidelines as Topic

In continuation of research aimed at identifying anti-inflammatory agents from natural sesquiterpenoids, an activity-guided fractionation approach utilizing lipopolysaccharide (LPS)-mediated RAW264.7 cells was employed to investigate chemical constituents from Inula Britannica (I. britannica). Seven novel sesquiterpenoid dimers inulabritanoids A-G (1-7) and two novel sesquiterpenoid monomers inulabritanoids H (8) and I (9) were isolated from I. britannica together with eighteen known compounds (10-27). The structural elucidation was accomplished through comprehensive analysis of 1D and 2D nuclear magnetic resonance (NMR), high-resolution mass spectrometry (HR-MS), and electronic circular dichroism (ECD) spectra, complemented by quantum chemical calculations. Compounds 1, 2, 12, 16, 19, and 26 demonstrated inhibitory effects on NO production, with IC₅₀ values of 3.65, 5.48, 3.29, 6.91, 3.12, and 5.67 μmol·L^-1, respectively. Mechanistic studies revealed that compound 1 inhibited IκB kinase β (IKKβ) phosphorylation, thereby blocking nuclear factor κB (NF-κB) nuclear translocation, and activated the kelch-like ECH-associated protein 1 (Keap1)/nuclear factor erythroid 2-related factor 2 (Nrf2) signal pathway, leading to decreased expression of NADPH oxidase 2 (NOX-2), inducible nitric oxide synthase (iNOS), tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), IL-1β, and IL-1α and increased expression of NAD(P)H: quinone oxidoreductase 1 (NQO-1) and heme oxygenase-1 (HO-1), thus exhibiting anti-inflammatory effects in vitro. These results indicate that dimeric sesquiterpenoids may serve as promising candidates for anti-inflammatory drug development.
Mice ; Animals ; Sesquiterpenes/isolation & purification* ; Anti-Inflammatory Agents/isolation & purification* ; Inula/chemistry* ; RAW 264.7 Cells ; Nitric Oxide ; Molecular Structure ; NF-kappa B/immunology* ; NF-E2-Related Factor 2/immunology* ; Macrophages/immunology* ; Nitric Oxide Synthase Type II/immunology* ; Plant Extracts/pharmacology* ; Lipopolysaccharides ; Tumor Necrosis Factor-alpha/immunology* ; I-kappa B Kinase/genetics*

Acute lung injury (ALI) is a significant complication of sepsis, characterized by high morbidity, mortality, and poor prognosis. Neutrophils, as critical intrinsic immune cells in the lung, play a fundamental role in the development and progression of ALI. During ALI, neutrophils generate neutrophil extracellular traps (NETs), and excessive NETs can intensify inflammatory injury. Research indicates that Taohe Chengqi decoction (THCQD) can ameliorate sepsis-induced lung inflammation and modulate immune function. This study aimed to investigate the mechanisms by which THCQD improves ALI and its relationship with NETs in sepsis patients, seeking to provide novel perspectives and interventions for clinical treatment. The findings demonstrate that THCQD enhanced survival rates and reduced lung injury in the cecum ligation and puncture (CLP)-induced ALI mouse model. Furthermore, THCQD diminished neutrophil and macrophage infiltration, inflammatory responses, and the production of pro-inflammatory cytokines, including interleukin-1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α). Notably, subsequent experiments confirmed that THCQD inhibits NET formation both in vivo and in vitro. Moreover, THCQD significantly decreased the expression of peptidyl arginine deiminase 4 (PAD4) protein, and molecular docking predicted that certain active compounds in THCQD could bind tightly to PAD4. PAD4 overexpression partially reversed THCQD's inhibitory effects on PAD4. These findings strongly indicate that THCQD mitigates CLP-induced ALI by inhibiting PAD4-mediated NETs.
Extracellular Traps/immunology* ; Acute Lung Injury/immunology* ; Animals ; Sepsis/immunology* ; Drugs, Chinese Herbal/pharmacology* ; Mice ; Neutrophils/immunology* ; Male ; Protein-Arginine Deiminase Type 4/genetics* ; Mice, Inbred C57BL ; Humans ; Disease Models, Animal ; Cytokines/metabolism*

OBJECTIVE: This study examines the sequential mediating roles of body pain and self-reported health in the association between sleep duration and self-reported life satisfaction among elderly Chinese adults. METHODS: Data from the fifth wave of the China Health and Retirement Longitudinal Survey (CHARLS) were used to analyse the relationships between sleep duration and body pain, self-reported health, and life satisfaction through logistic regression and Restricted Cubic Spline (RCS) analyses. The sequential mediation effects of body pain and self-reported health status were examined via chain mediation analysis. RESULTS: Logistic regression analysis showed that sleeping fewer than 6 hours or 6-7 hours was linked to higher risks of body pain, poor health, and dissatisfaction with life compared to sleeping 7-8 hours (all P < 0.05). Additionally, those sleeping more than 9 hours also had increased risks of poor health and dissatisfaction with life compared to those sleeping 7-8 hours (all P < 0.05). Chain mediation analysis showed that body pain and self-reported health status sequentially mediated 46.15% of the association between sleep duration and life satisfaction. CONCLUSION Body pain and self-reported health may shape the relationship between sleep duration and life satisfaction in elderly Chinese adults.
Humans ; Male ; Female ; Aged ; Personal Satisfaction ; Sleep ; Health Status ; Self Report ; China ; Middle Aged ; Longitudinal Studies ; Pain/psychology* ; Sleep Duration