ObjectiveTo characterize the features of the gut microbiome and its association with clinical prognosis in patients with intermediate and advanced hepatocellular carcinoma （HCC） treated with transcatheter arterial chemoembolization （TACE） combined with targeted therapy and immunotherapy. MethodsThis retrospective study enrolled patients with intermediate and advanced HCC who received TACE combined with targeted therapy and immunotherapy at the First Affiliated Hospital of Sun Yat-sen University from February 2025 to July 2025. Baseline clinical data and fecal samples were collected from all enrolled patients before the index hospitalization and treatment. Patients were stratified using two independent criteria： ① a good-prognosis group and a poor-prognosis group， based on whether progression-free survival （PFS） reached 6 months； ② a response group and a non-response group， based on tumor response to the first TACE assessed by the modified Response Evaluation Criteria in Solid Tumors （mRECIST）. Metagenomic sequencing was performed on fecal samples. Bioinformatic analysis was conducted to evaluate the diversity and compositional differences of intestinal bacterial and fungal communities between groups in each stratification， and to screen for prognosis-associated characteristic microbial taxa. ResultsA total of 61 patients met the inclusion criteria. Analysis of α-diversity and β-diversity showed no statistically significant differences in bacterial and fungal diversity between groups under either stratification strategy （P＞ 0.05）. At the bacterial level， Lactobacillus johnsonii （prognosis stratification： P=0.048； response stratification： P=0.043）， Bifidobacterium dentium （prognosis stratification： P=0.004； response stratification： P=0.030） and Clostridioides difficile （prognosis stratification： P=0.017； response stratification： P=0.016） were significantly enriched in both the good prognosis group and the response group. At the fungal level， Cryptococcus decaguttatus （P=0.045）， Puccinia striiformis （P=0.002）， and Kwoniella quercicola （P=0.015） were enriched in the good‑prognosis group； Kwoniella bestiolae （P=0.037） was enriched in the response group； and Akanthomyces muscarius （P=0.024） was enriched in the non-response group. Survival analysis based on the common differential bacterial abundance in both groupings showed a significant correlation between the abundance of Bifidobacterium dentium and patient prognosis. ConclusionDifferences in the gut microbiota are associated with the prognosis of patients with intermediate and advanced HCC treated with TACE combined with targeted therapy and immunotherapy. Bifidobacterium dentium may serve as a potential predictive biomarker for the efficacy of this combination regimen， and represents a potential intervention target to modulate treatment response. Differences in gut fungal communities are also potentially associated with the prognosis of intermediate and advanced HCC patients receiving TACE combined with targeted therapy and immunotherapy.

Objective To explore the effects of Shenyuan Yiqi Huoxue Capsules on cardiopulmonary exercise function and quality of life in patients with ischemic cardiomyopathy.Methods Totally 66 patients with ischemic cardiomyopathy were divided into treatment group and control group using random number table method,with 33 cases in each group.Both groups received standardized Western medicine treatment,and the treatment group was additionally given Shenyuan Yiqi Huoxue Capsules,the control group was given Shenyuan Yiqi Huoxue Capsules simulator,three capsules per time,three times a day,orally.The observation period was 30 days.To evaluate the efficacy of TCM syndrome in two groups.The observation indicators included baseline data,TCM syndrome scores,cardiopulmonary exercise test detection indicators,MLHFQ score,SF-36 score,echocardiographic indicators,N-terminal pro-B-type natriuretic peptide(NT-pro BNP)and safety indicators.Results The total effective rate of the treatment group was 93.94%(31/33),while that of the control group was 78.79%(26/33).The treatment group was significantly better than the control group(P<0.05).Compared with before treatment,the TCM syndrome scores of the two groups of patients decreased(P<0.05),and after treatment,the TCM syndrome score of the treatment group was lower than that of the control group(P<0.05).Compared with before treatment,the peak oxygen uptake(peak VO2),anaerobic threshold(AT)and peak oxygen pulse(peak O2 pulse)of both groups of patients increased,while the carbon dioxide ventilation equivalent slope(VE/VCO2 slope)decreased(P<0.05).After treatment,the treatment group had higher peak VO2,AT and peak O2 pulse than the control group,while the VE/VCO2 slope was lower than the control group(P<0.05).Compared with before treatment,both groups of patients showed a decrease in MLHFQ score and an increase in SF-36 score(P<0.05);after treatment,the MLHFQ score in the treatment group was lower than that in the control group,and the SF-36 score was higher than that in the control group(P<0.05).Compared with before treatment,both groups of patients showed a decrease in left ventricular end systolic diameter,left ventricular end diastolic diameter and NT-pro BNP levels,while myocardial motion index and left ventricular ejection fraction increased(P<0.05);after treatment,the treatment group showed a decrease in left ventricular end systolic diameter,left ventricular end diastolic diameter and NT-pro BNP levels,while myocardial motion index and left ventricular ejection fraction increased(P<0.05).During the treatment period,no adverse reactions such as dizziness,nausea,vomiting or diarrhea were found in both groups of patients.Conclusion Shenyuan Yiqi Huoxue Capsules can significantly improve the clinical efficacy of ischemic cardiomyopathy patients,alleviate TCM symptoms,improve their cardiorespiratory function and quality of life.

Objective To explore the effects of Shenyuan Yiqi Huoxue Capsules on cardiopulmonary exercise function and quality of life in patients with ischemic cardiomyopathy.Methods Totally 66 patients with ischemic cardiomyopathy were divided into treatment group and control group using random number table method,with 33 cases in each group.Both groups received standardized Western medicine treatment,and the treatment group was additionally given Shenyuan Yiqi Huoxue Capsules,the control group was given Shenyuan Yiqi Huoxue Capsules simulator,three capsules per time,three times a day,orally.The observation period was 30 days.To evaluate the efficacy of TCM syndrome in two groups.The observation indicators included baseline data,TCM syndrome scores,cardiopulmonary exercise test detection indicators,MLHFQ score,SF-36 score,echocardiographic indicators,N-terminal pro-B-type natriuretic peptide(NT-pro BNP)and safety indicators.Results The total effective rate of the treatment group was 93.94%(31/33),while that of the control group was 78.79%(26/33).The treatment group was significantly better than the control group(P<0.05).Compared with before treatment,the TCM syndrome scores of the two groups of patients decreased(P<0.05),and after treatment,the TCM syndrome score of the treatment group was lower than that of the control group(P<0.05).Compared with before treatment,the peak oxygen uptake(peak VO2),anaerobic threshold(AT)and peak oxygen pulse(peak O2 pulse)of both groups of patients increased,while the carbon dioxide ventilation equivalent slope(VE/VCO2 slope)decreased(P<0.05).After treatment,the treatment group had higher peak VO2,AT and peak O2 pulse than the control group,while the VE/VCO2 slope was lower than the control group(P<0.05).Compared with before treatment,both groups of patients showed a decrease in MLHFQ score and an increase in SF-36 score(P<0.05);after treatment,the MLHFQ score in the treatment group was lower than that in the control group,and the SF-36 score was higher than that in the control group(P<0.05).Compared with before treatment,both groups of patients showed a decrease in left ventricular end systolic diameter,left ventricular end diastolic diameter and NT-pro BNP levels,while myocardial motion index and left ventricular ejection fraction increased(P<0.05);after treatment,the treatment group showed a decrease in left ventricular end systolic diameter,left ventricular end diastolic diameter and NT-pro BNP levels,while myocardial motion index and left ventricular ejection fraction increased(P<0.05).During the treatment period,no adverse reactions such as dizziness,nausea,vomiting or diarrhea were found in both groups of patients.Conclusion Shenyuan Yiqi Huoxue Capsules can significantly improve the clinical efficacy of ischemic cardiomyopathy patients,alleviate TCM symptoms,improve their cardiorespiratory function and quality of life.

Objective:To establish and validate a predictive model for non-curative resection of rectal neuroendocrine tumors (R-NETs) ≤20 mm.Methods:Data from patients with R-NETs treated at the First Affiliated Hospital of Soochow University and the Suzhou Ninth People's Hospital from January 2013 to December 2023 were retrospectively analyzed. Clinical data, endoscopic findings, and pathological characteristics were analyzed. Univariate analysis was performed using independent sample t-tests and Chi-square tests. Variables were screened using the forward stepwise binary logistic regression to establish a risk prediction model for non-curative resection of R-NETs ≤20 mm, with subsequent construction of a nomogram. The performance of the model was evaluated using the receiver operating characteristic (ROC) curve. The consistency between predicted and observed probabilities was assessed using calibration curves, and the clinical net benefit of the model was evaluated using decision curve analysis. Results:A total of 213 patients were included, with age of 50.53±11.42 years, and 102 (47.9%) were male. The distance of the lesion from the dentate line was 7.11±2.79 cm, and the tumor long diameter was 8.24±3.75 mm. Compared to curative resection cases, non-curative resection cases were more likely to exhibit tumor surface depression, higher tumor G-stage, higher Ki-67 index and higher chromograninA (CgA) positivity rate ( P<0.05). Through forward variable selection in binary logistic regression, a model was established with Ki-67 index ( P=0.014, OR=1.214, 95% CI: 1.039-1.417), surface depression ( P=0.027, OR=2.348, 95% CI: 1.100-5.013), and CgA positivity ( P<0.001, OR=5.399, 95% CI: 2.764-10.544) as parameters, with a corresponding nomogram. The area under the ROC curve of the model was 0.766 (95% CI: 0.696-0.837), and clinical decision curve analysis confirmed its good clinical net benefit. The calibration curve showed good consistency between predicted and observed probabilities. Conclusion:This study establishes a risk prediction model for non-curative resection of R-NETs ≤20 mm based on surface depression, Ki-67 index, and CgA positivity. The model demonstrates strong predictive performance and offers valuable guidance for clinical endoscopists.

Objective To investigate the diagnostic value of endoscopic ultrasonography(EUS)and contrast-enhanced endoscopic ultrasonography(CE-EUS)with sulfur hexafluoride microbubbles for injection in upper gastrointestinal submucosal tumors(SMT).Methods The subjects of this study were 82 upper gastrointestinal SMT patients from January 2021 to August 2023.All of them underwent EUS and CE-EUS using sulfur hexafluoride microbubbles as contrast agents.Features of EUS images of upper gastrointestinal benign SMT and gastrointestinal stromal tumor(GIST),and CE-EUS images using sulfur hexafluoride microbubbles as contrast agents were analyzed.EUS,CE-EUS using sulfur hexafluoride microbubbles as contrast agents,and combination of the two were compared in upper gastrointestinal benign SMT and GIST diagnosis based on surgical pathological findings as the golden standard.Results 82 cases of upper gastrointestinal SMT were confirmed by imaging examination and surgical results to have tumors located in the upper,middle,lower segments esophagus,cardia,fundus,body,antrum of stomach,and duodenal bulb,accounting for 7.32%,10.98%,10.98%,4.88%,29.27%,26.83%,6.10%,and 3.66%respectively.According to pathological results,there were 51 cases of upper gastrointestinal benign SMT,accounting for 62.20%and 31 cases of GIST,accounting for 37.80%.Among them,SMT in the upper gastrointestinal tract was mainly located in the esophagus and stomach,with leiomyoma being the most common.GIST was mainly located in the stomach and was more common in the fundus and body of the stomach.The proportion of benign SMT group with uniform echo,smooth surface mucosa,and regular edges was significantly higher than that of GIST group(P＜0.05).GIST group had much higher proportion in doppler rich blood flow signals and origination from the muscularis propria than benign SMT group did(P＜0.05).There was no difference between the two groups in terms of proportion of echo properties(P＞0.05).The proportion of homogeneous enhancement in the benign SMT group was significantly higher than that in the GIST group(P＜0.05).The proportion of arterial phase hyperenhancement,venous phase diffuse enhancement,and irregular blood vessels in the GIST group was significantly higher than that in the benign SMT group(P＜0.05).The sensitivity,specificity,and accuracy of EUS in distinguishing GIST and benign SMT were 64.52%,74.51%,and 70.73%respectively,those of the CE-EUS using sulfur hexafluoride microbubbles as contrast agent were 90.32%,88.24%,and 89.02%respectively,and those of EUS+CE-EUS using sulfur hexafluoride microbubbles as contrast agent were 100.00%,90.20%,and 93.90%respectively.Conclusion EUS and CE-EUS with sulfur hexafluoride microbubbles as contrast agents has high diagnostic value for upper gastrointestinal benign SMT and GIST.

Objective·To explore the relationship between abdominal fat area and the first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes,and to establish predictive models of nomogram.Methods·From October 2020 to February 2024,a total of 120 patients with type 2 diabetes,who were hospitalized in the Department of Endocrinology,Zhongshan Hospital,Fudan University,and underwent the arginine stimulation test,were recruited for the study.Patients were categorized into an insulin secretion function-preserved group(i.e.preserved group)and a depleted group according to the results of the arginine stimulation test.General information and laboratory parameters were collected.Subcutaneous fat area(SFA)and visceral fat area(VFA)were non-invasively measured by abdominal fat detector.The variables were screened by univariate analysis,and multivariate Logistic regression was used to identify the influencing factors,followed by the establishment of predictive models of nomogram.The area under the receiver operating characteristic curve(ROC curve)and concordance index(C-index)were used to evaluate the predictive performance of the models.Results·Seventy-four patients(61.7%)were assigned to the preserved group,and 46 patients(38.3%)to the depleted group.Patients in the depleted group had a longer diabetes duration,lower waist circumference,hip circumference,body mass index(BMI),uric acid,free triiodothyronine(FT3),adipose tissue insulin resistance(Adipo-IR),ankle brachial index(ABI),SFA and VFA,and higher brachial ankle pulse wave velocity(baPWV).Multivariate Logistic regression showed that SFA,VFA,FT3,baPWV,and ABI were independent risk factors for the depleted insulin secretion function.Nomogram models were constructed based on the above risk factors.Among them,the model comprising VFA,FT3,ABI,and baPWV showed the best predictive performance with a C-index of 0.81.Conclusion·SFA and VFA are lower in patients with depleted first-phase insulin secretion function of pancreatic β-cells.The nomogram model,including SFA or VFA,can be used to predict first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes.

Objective:To establish and validate a predictive model for non-curative resection of rectal neuroendocrine tumors (R-NETs) ≤20 mm.Methods:Data from patients with R-NETs treated at the First Affiliated Hospital of Soochow University and the Suzhou Ninth People's Hospital from January 2013 to December 2023 were retrospectively analyzed. Clinical data, endoscopic findings, and pathological characteristics were analyzed. Univariate analysis was performed using independent sample t-tests and Chi-square tests. Variables were screened using the forward stepwise binary logistic regression to establish a risk prediction model for non-curative resection of R-NETs ≤20 mm, with subsequent construction of a nomogram. The performance of the model was evaluated using the receiver operating characteristic (ROC) curve. The consistency between predicted and observed probabilities was assessed using calibration curves, and the clinical net benefit of the model was evaluated using decision curve analysis. Results:A total of 213 patients were included, with age of 50.53±11.42 years, and 102 (47.9%) were male. The distance of the lesion from the dentate line was 7.11±2.79 cm, and the tumor long diameter was 8.24±3.75 mm. Compared to curative resection cases, non-curative resection cases were more likely to exhibit tumor surface depression, higher tumor G-stage, higher Ki-67 index and higher chromograninA (CgA) positivity rate ( P<0.05). Through forward variable selection in binary logistic regression, a model was established with Ki-67 index ( P=0.014, OR=1.214, 95% CI: 1.039-1.417), surface depression ( P=0.027, OR=2.348, 95% CI: 1.100-5.013), and CgA positivity ( P<0.001, OR=5.399, 95% CI: 2.764-10.544) as parameters, with a corresponding nomogram. The area under the ROC curve of the model was 0.766 (95% CI: 0.696-0.837), and clinical decision curve analysis confirmed its good clinical net benefit. The calibration curve showed good consistency between predicted and observed probabilities. Conclusion:This study establishes a risk prediction model for non-curative resection of R-NETs ≤20 mm based on surface depression, Ki-67 index, and CgA positivity. The model demonstrates strong predictive performance and offers valuable guidance for clinical endoscopists.

ObjectiveTo systematically evaluate the efficacy and safety of Qi-reinforcing and blood-activating/stasis-expelling Chinese patent medicines in the treatment of coronary microvascular disease （CMD）. MethodsPubMed， Cochrane Library， CNKI， Wanfang Data， and VIP were searched for the randomized controlled trials （RCTs） on the treatment of CMD with Chinese patent medicines for reinforcing Qi and activating blood/expelling stasis with the time interval from inception to December 31， 2023. The primary outcome indicators included the index of microcirculatory resistance （IMR）， coronary flow reserve （CFR）， and corrected TIMI flow frame count （cTFC）. The secondary outcome indicators included symptomatic efficacy， left ventricular ejection fraction （LVEF）， hypersensitive C-reactive protein （hs-CRP）， nitric oxide （NO）， and adverse events. Cochrane risk-of-bias assessment tool 2.0 （RoB 2.0） and Stata 17.0 were used for literature quality evaluation and meta-analysis of the included RCTs. The Grading of Recommendations， Assessment， Development and Evaluation （GRADE） was used to evaluate the quality of evidence. ResultsA total of 36 RCTs were included in this study， involving 3 029 patients. Compared with conventional Western medicine alone， the combined use of Chinese patent medicines for reinforcing Qi and activating blood/expelling stasis and Western medicine reduced the IMR ［mean difference （MD）=-5.93， 95% confidence interval （95%CI） ［-8.73，-3.14］， n=382， P<0.01］， cTFC （MD=-9.35， 95%CI ［-13.94，-4.76］， n=618， P<0.01）， and hs-CRP ［standard mean difference （SMD）=-1.50， 95%CI ［-1.90，-1.11］， n=1 483， P<0.01］， improved the CFR （SMD=1.14， 95%CI ［0.08，2.19］， n=304， P=0.03）， symptomatic efficacy ［relative risk （RR）=1.36， 95%CI ［1.21，1.53］， n=756， P<0.01］， LVEF （MD=4.39， 95%CI ［2.31，6.47］， n=533， P<0.01）， and NO （SMD=3.16， 95%CI ［2.07，4.25］， n=946， P<0.01） of CMD patients. In terms of safety， the combined therapy reduced the occurrence of adverse events in CMD patients （RR=0.49， 95%CI ［0.29，0.82］， n=591， P=0.01）. GRADE showed moderate quality evidence for adverse events， low quality evidence for cTFC， symptomatic efficacy， LVEF， and NO， and very low quality evidence for IMR， CFR， and hs-CRP. ConclusionBased on microcirculatory function indicators， the combined use of Qi-reinforcing and blood-activating/stasis-expelling Chinese patent medicines and Western medicine may further improve the coronary microvascular function in CMD patients with good safety. The above conclusions remain to be verified with high-quality clinical trials.

ObjectiveTo study the effect of Taikong Yangxin Pills on the metabolism of simulated weightless rats based on metabolomics and discuss the metabolism mechanism. MethodsIn the simulated space capsule environment on the ground， the rat model of simulated weightlessness was established by the tail suspension method. Rats were randomly grouped as follows： out-of-capsule control， in-capsule control， model， and high （3.0 g·kg^-1） and low （1.5 g·kg^-1） doses of Taikong Yangxin Pills， and they were administrated with corresponding drugs by gavage for 28 days. The serum levels of endogenous metabolites in rats were determined by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry （UPLC-Q-TOF/MS）. The obtained data were processed by principal component analysis （PCA） and orthogonal partial least squares-discriminant analysis （OPLS-DA） to screen for differential metabolites and potential biomarkers. MetaboAnalyst 5.0 was used for pathway enrichment analysis to explain the metabolic regulation mechanism of the drug. ResultsCompared with the out-of-capsule control group， the in-capsule control group showed elevated levels of thirteen metabolites， including 14-hydroxyhexadecanoic acid， linoleic acid， and α-linolenic acid （P<0.05）， which suggested that the space capsule environment mainly affected the metabolism of α-linolenic acid and linoleic acid in the rats. Compared with the in-capsule control group， the model group showed lowered levels of fourteen metabolites， including 4-imidazolone-5-propionic acid， isocitric acid/citric acid， and L-tyrosine （P<0.05）， which were recovered after the treatment with Taikong Yangxin pills （P<0.05）. The pathway enrichment analysis revealed that weightlessness induced by tail suspension and drug intervention mainly involved the phenylalanine， tyrosine， and tryptophan biosynthesis， tyrosine metabolism， histidine metabolism， and citric acid cycle. ConclusionThe simulated space capsule environment and simulated weightlessness induced by tail suspension can both affect the metabolism level of rats. Taikong Yangxin pills can ameliorate the metabolic abnormality in the rat model of weightlessness by regulating various amino acids and energy metabolism-related pathways.

With the ongoing development of nuclear energy,radiotherapy,and space exploration,ionizing radiation poses a growing threat to human health.Studies have confirmed that high-intensity or prolonged exposure can lead to apoptosis,genetic damage,immune dysfunction,and multisystem disorders,underscoring the urgent need for effective protective strategies.This review aims to explore the molecular mechanisms of traditional Chinese medicine(TCM)in radiation protection and assess its potential applications in extreme environments such as aerospace.A systematic literature review was conducted to summarize existing research on anti-radiation effects of single herbs,compound prescriptions,and Chinese patent medicines.The pharmacological features and action mechanisms of heat-clearing and detoxifying,tonifying,blood-activating,and tranquilizing herbs were analyzed,with emphasis on their applications in radiotherapy support and aerospace radiation protection.TCM exerts radioprotective effects through multiple biological pathways,including antioxidation,free radical scavenging,DNA repair,immune regulation,and tissue regeneration.Some Chinese patent medicines have been clinically applied as adjuncts to chemo-and radiotherapy,demonstrating benefits in reducing side effects and improving treatment tolerance.Certain herbal components have also shown promising potential in space radiation protection research.TCM has significant potential in radiation protection,particularly in high-risk settings such as spaceflight,where it offers integrated regulatory and protective effects.Future research should focus on elucidating mechanisms,standardizing efficacy evaluation,and promoting clinical translation to support its broader application in nuclear energy,medical radiotherapy,and deep space exploration.