Hepatolenticular degeneration， also known as Wilson disease （WD）， is a hereditary disease caused by mutations in the ATP7B gene， leading to copper metabolism disorders. Gene mutations result in impaired synthesis of copper-binding protein， and abnormal excretion of copper through bile leads to pathological deposition of copper in various organs， ultimately causing multi-organ damage. The insidious onset and low specificity of symptoms make it difficult to diagnose this disease. On the basis of existing studies and the theory of latent toxin， this paper proposes that latent toxin in kidney collaterals is the main pathogenesis of renal injury in WD. It is pointed out that health Qi deficiency and latent pathogen are the premises for the occurrence of this disease， and the transformation of latent pathogen into toxin is the ley pathological process. Toxin damaging kidney collaterals is the ultimate result. According to the pathogenesis， this paper proposes the treatment principle of reinforcing healthy Qi and resolving toxin and treatment based on syndrome differentiation. This review provides new ideas for the diagnosis and treatment of renal injury in WD with traditional Chinese medicine.

ObjectiveTo observe the clinical efficacy of Gandouling decoction combined with neuromuscular electrical stimulation （NMES） in the treatment of dysphagia in Wilson disease （WD） with combined phlegm and stasis. MethodsA total of 80 WD patients with dysphagia due to combined phlegm and stasis treated in the Department of Encephalopathy， the First Affiliated Hospital of Anhui University of Chinese Medicine were randomized into a control group and an observation group， with 40 patients in each group. In addition， 40 healthy volunteers were recruited as the normal group. The control group was treated with basic copper drainage combined with NMES. The observation group was treated with Gandouling Decoction on the basis of the therapy in the control group. Each course of treatment lasted for 8 days， and the patients were treated for a total of 4 courses. All subjects underwent video fluoroscopic swallowing study （VFSS） before and after treatment. During the examination， contrast agents with 4 different characters were used for the swallowing action， and the passing time was recorded. The TCM syndrome score， water swallow test score， standard swallowing assessment （SSA） score， and 24-h urinary copper level before and after treatment were analyzed. ResultsWhen performing VFSS， the passing time of contrast agents of different characters in the oral stage was longer in the WD group than in the normal group （P<0.01）， while it had no significant difference in the pharyngeal stage. After treatment， the passing time in the oral stage shortened in the control and observation groups （P<0.01）， and the observation group outperformed the control group （P<0.01）. After treatment， both the control and observation groups showed declines in TCM syndrome score and SSA score （P<0.01） and an increase in water swallow test score （P<0.01）， and the changes were more obvious in the observation group than in the control group （P<0.01）. In addition， the treatment in the control and observation groups elevated the 24-h urinary copper level （P<0.01）， and the elevation in the observation group was more obvious than that in the control group （P<0.01）. Neither group showed obvious adverse reaction. ConclusionGandouling decoction combined with NMES can significantly ameliorate dysphagia in WD patients with the syndrome of combined phlegm and stasis regarding the TCM syndrome score， water swallow test score， and SSA score， demonstrating definite clinical efficacy and high safety.

Wilson disease is a copper metabolism disorder caused by mutations in the ATP7B gene， which encodes a copper-transporting ATPase β， and can result in multisystem damage. The kidneys are the third most commonly affected organs after the liver and brain. In recent years， numerous diagnostic and treatment guidelines for Wilson disease have emerged. However， most of these focus primarily on hepatic and neurological manifestations and their management， with limited coverage of renal involvement. The high incidence， low awareness， and lack of clinical specificity of Wilson disease-related renal damage （WDRD） have made early detection and intervention particularly challenging in clinical practice. To further optimize the treatment of patients with WDRD， improve clinical diagnosis and management， and enhance patients' quality of life， the Neurology Committee of the Chinese Association of Integrative Medicine， in April 2024， initiated a revision of the first expert consensus on the integrated diagnosis， treatment， and management of WDRD. This effort brought together experts in hepatology， encephalopathy （neurology）， and nephrology from many tertiary-level grade A hospitals and research institutions across China. Through comprehensive literature review and integration of frontline clinical experience， the expert group jointly developed Chinese Expert Consensus on Integrated Chinese and Western Medicine Management of Wilson Disease-related Renal Damage （hereinafter referred to as the "Consensus"）. This article provides a detailed interpretation of the Consensus in terms of diagnostic criteria， traditional Chinese medicine （TCM） syndrome differentiation and treatment classification， and comprehensive disease management， aiming to better guide clinical application. Regarding diagnostic criteria， the Consensus integrates the latest standards in China and abroad， highlights the importance of biochemical diagnosis， and compensates for the limitations of genetic testing. In the area of TCM syndrome differentiation and treatment， the Consensus refines four major syndrome types， introduces a newly defined syndrome， i.e.， phlegm， blood stasis， and heat accumulation， and elaborates on treatment principles， prescriptions， and clinical modification rules for each syndrome. For comprehensive disease management， the Consensus emphasizes multi-dimensional intervention strategies， including diet， exercise， emotional regulation， medication， and medical care， with the goal of maximally controlling the progression of renal dysfunction and helping patients achieve a better quality of life.

Objective To study the expression of amplified in breast cancer 1(AIB1)and ankyrin repeat domain containing11(ANKRD11/ANCO1)in human papillomavirus(HPV)positive cervical cancer and their relationship with clinicopathological characteristics and their predictive value for postoperative recurrence.Methods Cancer tissues and paracancer tissues of 94 HPV positive cervical cancer patients who visited the Third People's Hospital of Mianyang from January 2018 to January 2020 were selected,while 50 HPV negative cervical cancer tissues during this period were taken as controls.Real-time qPCR(RT-qPCR)was conducted to detect AIB1 mRNA and ANCO1 mRNA expression in cancer tissue and paracancer tissues of HPV positive cervical cancer and cancer tissue of HPV negative cervical.Pearson analysis of the correlation between AIB1 mRNA and ANCO1 mRNA expression in HPV positive cervical cancer tissues.Logistic regression analysis was used to identify the risk factors for postoperative recurrence of HPV-positive cervical cancer patients.The predictive value of AIB1 mRNA,ANCO1 mRNA,and their combination in predicting postoperative recurrence in HPV positive cervical cancer patients was analyzed by receiver operating characteristic curve.Results Compared to the adjacent tissues of HPV positive cervical cancer and cancer tissues of HPV negative cervical cancer,AIB1 mRNA(3.04±0.37 vs 0.87±0.21,1.02±0.33)in HPV positive cervical cancer tissues was higher,while ANCO1 mRNA(1.13±0.26 vs 1.91±0.35,1.82±0.36)was lower,with significant differences(t=68.499,53.137;23.649,17.434,all P<0.05).The expression of AIB1 mRNA and ANCO1 mRNA in HPV positive cervical cancer tissues showed a negative correlation(r=-0.714,P<0.001).Compared to patients with FIGO stage ⅡA～ⅡB and without lymph node metastasis,AIB1 mRNA(3.88±0.32 vs 2.04±0.41,4.46±0.33 vs 2.16±0.46)in HPV positive cervical cancer tissues with FIGO stage ⅡA and lymph node metastasis was higher,while ANCO1 mRNA(0.67±0.29 vs 1.68±0.20,0.49±0.24 vs 1.53±0.32)was lower,with significant differences(t=24.425,26.097;19.288,16.777,all P<0.001).FIGO stage ⅡA,lymph node metastasis,and high AIB1 mRNA[OR(95％CI)=1.644(1.223～2.210),1.779(1.295～2.444),1.247(1.050～1.728)]were risk factors for postoperative recurrence in HPV positive cervical cancer patients,while high ANCO1 mRNA[(OR(95％CI):0.634(0.451～0.891)]was a protective factor.The AUC(95％CI)of AIB1 mRNA and ANCO11 mRNA combined for predicting postoperative recurrence in HPV positive cervical cancer patients was 0.914(0.863～0.952),which was higher than the single indicator detection of 0.821(0.782～0.869)and 0.794(0.763～0.847),and the differences were significant(Z=4.123,4.432,all P<0.001).Conclusion The expression of AIB1 mRNA is increased and the expression of ANCO1 mRNA is reduced in HPV positive cervical cancer tissue,which are related to the occurrence and progression of cancer.The combination of the two has a high predictive value for evaluating postoperative recurrence.

Objective: To compare the effects of three treatment options: emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery, on the pathological characteris- tics of surgically-resected specimens from patients with completely obstructive colorectal cancer. Methods: This was a retrospective cohort study analyzing clinicopathological data of patients with complete obstructive colorectal cancer who were admitted to the General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, between May 2012 and August 2020. The inclusion criteria were diagnosed with complete colorectal obstruction, pathologically confirmed as adenocarcinoma, resectable on imaging assessment, and without distant metastasis, combined with the patients' clinical manifestations and imaging examination findings. Patients with multiple colorectal cancers, refusal to undergo surgery, and concurrent peritonitis or intestinal perforation before stenting of the intestinal obstruction were excluded. Eighty-nine patients with completely obstructive colorectal cancer were enrolled in the study and were divided into emergency surgery group (n=30), stent-surgery group (n=34), and stent-neoadjuvant chemotherapy- surgery group (n=25) according to the treatment strategy. Differences in the pathological features (namely perineural infiltration, lymphovascular infiltration, tumor deposits, specimen intravascular necrosis, inflammatory infiltration, abscesses, mucus lake formation, foreign body giant cells, calcification, and tumor cell ratio) and biomolecular markers (namely cluster of differentiation (CD)34, Ki67, Bcl-2, matrix metalloproteinase-9, and hypoxia-inducible factor alpha) were recorded. Pathological evaluation was based on the presence or absence of qualitative evaluation of pathological features, such as peripheral nerve infiltration, vascular infiltration, and cancer nodules within the specimens. The evaluation criteria for the pathological features of the specimens were as follows: Semi-quantitative graded evaluation based on the proportion of tissue necrosis, inflammatory infiltrates, abscesses, mucus lake formation, foreign body giant cells, calcification, and tumor cells in the field of view within the specimen were classified as: grade 0: not seen within the specimen; grade 1: 0-25%; grade 2: 25%-50%; grade 3: 50%-75%; and grade 4: 75%-100%. The intensity of cellular immunity was classified as none (0 points), weak (1 point), moderate (2 points), and strong (3 points). The two evaluation scores were then multiplied to obtain a total score of 0-12. The immunohistochemical results were also evaluated comprehensively, and the results were defined as: negative (grade 0): 0 points; weakly positive (grade 1): 1-3 points; moderately positive (grade 2): 4-6 points; strongly positive (grade 3): 7-9 points; and very strong positive (grade 4): 10-12 points. Normally-distributed values were expressed as mean±standard deviation, and one-way analysis of variance was used to analyze the differences between the groups. Non-normally-distributed values were expressed as median (interquartile range: Q1, Q3). A nonparametric test (Kruskal-Wallis H test) was used for comparisons between groups. Results: The differences were not statistically significant when comparing the baseline data for age, gender, tumor site, American Society of Anesthesiologists score, tumor T-stage, N-stage, and degree of differentiation among the three groups (all P>0.05). The differences were not statistically significant when comparing the pathological characteristics of the resected tumor specimens, such as foreign body giant cells, inflammatory infiltration, and mucus lake formation among the three groups (all P>0.05). The rates of vascular infiltration were 56.6% (17/30), 41.2% (15/34), and 20.0% (5/25) in the emergency surgery, stent-surgery, and stent- neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences between the groups (χ²=7.142, P=0.028). Additionally, the rate of vascular infiltration was significantly lower in the stent-neoadjuvant chemotherapy-surgery group than that in the emergency surgery group (P=0.038). Peripheral nerve infiltration rates were 55.3% (16/30), 41.2% (14/34), and 16.0% (4/25), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (χ²=7.735, P=0.021). The infiltration peripheral nerve rates in the stent-neoadjuvant chemotherapy-surgery group were significantly lower than those in the emergency surgery group (P=0.032). The necrosis grade was 2 (1, 2), 2 (1, 3), and 2 (2, 3) in the emergency surgery, stent- surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=10.090, P=0.006). Post hoc comparison revealed that the necrosis grade was higher in the stent-surgery and stent-neoadjuvant chemotherapy-surgery groups compared with the emergency surgery group (both P<0.05). The abscess grade was 2 (1, 2), 3 (1, 3), and 2 (2, 3) in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=6.584, P=0.037). Post hoc comparison revealed that the abscess grade in the emergency surgery group was significantly lower than that in the stent-surgery group (P=0.037). The fibrosis grade was 2 (1, 3), 3 (2, 3), and 3 (2, 3), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=11.078, P=0.004). Post hoc analysis revealed that the fibrosis degree was higher in both the stent-surgery group and the stent- neoadjuvant chemotherapy-surgery group compared with the emergency surgery group (both, P<0.05). The tumor cell ratio grades were 4 (3, 4), 4 (3, 4), and 3 (2, 4), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=8.594, P=0.014). Post hoc analysis showed that the tumor cell ratio in the stent-neoadjuvant chemotherapy-surgery group was significantly lower than that in the emergency surgery group (P=0.012). The CD34 grades were 2 (2, 3), 3 (2, 4), and 3 (2, 3) in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, and the difference was statistically significant (H=9.786, P=0.007). Post hoc analysis showed that the CD34 grades in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups were 2 (2, 3), 3 (2, 4), and 3 (2,3), respectively. Post hoc analysis revealed that the CD34 concentration was higher in the stent-surgery group than that in the emergency surgery group (P=0.005). Conclusion: Stenting may increase the risk of distant metastases in obstructive colorectal cancer. The stent-neoadjuvant chemotherapy-surgery treatment model promotes tumor cell necrosis and fibrosis and reduces the proportion of tumor cells, vascular infiltration, and peripheral nerve infiltration, which may help decrease local tumor infiltration and distant metastasis in completely obstructive colorectal cancer after stent placement.
Humans ; Neoadjuvant Therapy/methods* ; Abscess ; Retrospective Studies ; Intestinal Obstruction/etiology* ; Stents ; Colorectal Neoplasms/therapy* ; Necrosis

【Objective】 To investigate the dynamic changes of local and systemic inflammatory responses after high-fat diet feeding of ApoE^-/- mice so as to establish the method to assess the recruitment of PKH26-labeled monocytes into atherosclerotic plaque. 【Methods】 ApoE^-/- mice that had received a high-fat diet (HFD) for 8 and 16 weeks were assessed for: ① atherosclerotic plaque burden (oil red O staining), ② aortic tissue inflammation (by RT-qPCR to detect aortic inflammatory factors and cells), ③ systemic inflammatory responses (by ELISA to measure plasma proinflammatory cytokine levels and flow cytometry to assess inflammatory cellular profile in the peripheral blood), and ④ recruitment of PKH26 labeled monocytes into atherosclerotic lesions (by confocal microscope). 【Results】 Compared to those in high-fat diet 8 weeks group, ApoE^-/- mice in high-fat diet 16 weeks group had more serious atherosclerosis in the whole aorta and aortic root (P<0.01); significantly up-regulated aortic mRNA levels of inflammatory factors CCL2, TNF-α and IL-1β (P<0.01); an increased number of aortic local macrophages (P<0.001); significantly increased protein expression of plasma CCL2 and TNF-α (P<0.01); and the increased percentage of peripheral blood monocytes (P<0.05). Moreover, the number of PKH26 labeled monocytes that migrated to aortic lesions were significantly higher in high-fat diet 16 weeks group (P<0.01). 【Conclusion】 High-fat diet promotes the severity of systemic and local inflammatory responses in ApoE knockout mice, which contributes to the migration of peripheral blood monocytes to atherosclerotic plaque.

Objective: To investigate differentially expressed genes and related signaling pathways in patients with dermatomyositis/clinical amyopathic dermatomyositis (DM/CADM) complicated by interstitial lung disease or malignant tumors. Methods: From January 2017 to January 2018, 27 DM/CADM patients were enrolled from Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, and divided into 3 groups according to the complications: 10 with interstitial lung disease, 8 with malignant tumors, and 9 without interstitial lung disease or malignant tumors. Meanwhile, 7 healthy controls were enrolled into this study. High-throughput RNA sequencing was performed to screen differentially expressed genes in peripheral blood in the above 4 groups. Then, these genes were subjected to gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Results: Compared with the healthy controls, 4 820 up-regulated genes and 137 down-regulated genes were identified in DM/CADM patients; GO analysis revealed 49 significantly enriched items in the DM/CADM patients, 37 (75.5%) of which were associated with biological processes; KEGG analysis showed that differentially expressed genes were mainly enriched in infection-, tumor- and immune-related pathways in DM/CADM patients. Compared with the patients without interstitial lung disease or malignant tumors, 272 up-regulated genes and 158 down-regulated genes were identified in the patients with interstitial lung disease; GO analysis revealed 157 significantly enriched items, 114 (72.6%) of which were associated with biological processes; KEGG analysis showed that differentially expressed genes were mainly enriched in bacterial infection- and autoimmune/inflammatory-related pathways in the patients with interstitial lung disease. Compared with the patients without interstitial lung disease or malignant tumors, 398 up-regulated genes and 68 down-regulated genes were identified in the patients with malignant tumors; GO analysis revealed 117 significantly enriched items, 94 (80.3%) of which were associated with biological processes; KEGG analysis showed that differentially expressed genes were mainly enriched in glycosylation-, metabolism- and tumor-related signaling pathways in the patients with malignant tumors. Conclusions Differences existed in transcriptomes and pathways between the DM/CADM patients and healthy controls, as well as between the patients with interstitial lung disease or malignant tumors and patients without these complications. Bacterial infection- and cytokine/chemokine-related pathways were significantly enriched in the patients with DM/CADM complicated by interstitial lung disease, while those pathways related to glycosylation, protein metabolism, angtigen presentation and cytotoxic effects of natural killer cells were significantly enriched in the patients with DM/CADM complicated by malignant tumors.

Objective: To study the chemical constituents from the fruits of Solanum virginianum. Methods: By means of preparative HPTLC and column chromatography over silica gel and Sephadex LH-20, compounds were isolated and purified. Their structures were elucidated by physico-chemical properties and spectral analyses. Results: Twelve compounds were obtained and identified as: 5-hydroxy-8-methoxy-6,7-methylenedioxyflavone (1), 7-hydroxy-6-methoxy coumarin (2), fraxetin (3), 5-hydroxy- 6,7,3',4'-tetramethoxyflavone (4), 5-hydroxy-4',6,7-trimethoxyflavone (5), dihydro-N-feruloyltyramine (6), N-trans-coumaroyltyramine (7), 5,3'-dihydroxy-6,7,4'-tritermethoxyflavone (8), N-[2-(3,4-dihydroxyphenyl)-2-hydroxyethyl]-3-(4-methoxyphenyl)-prop-2-enamide (9), N-trans-coumaroyloctopamine (10), 5,7,4'-trihydroxy-6-methoxyflavone (11), and 5,7,4'-trihydroxy-8-methoxyflavone (12). Conclusion: Compound 1 is a new flavonoid, named as solacarpumon, and compounds 2-12 are isolated from Solanum virginianum for the first time.

Objective: To investigate the clinical features of anti-signal recognition particle (SRP) antibody-positive patients with dermatomyositis/clinically amyopathic dermatomyositis (DM/CADM) . Methods: Clinical data were collected from 90 patients with DM/CADM, who were hospitalized at the Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from June 2015 to July 2017. Immunoblotting assay was performed to determine the serum level of anti-SRP antibody in these patients. Statistical analysis was carried out using t test and Chi-square test. Results: Of the 90 patients with DM/CADM, 11 (12.2%) were positive for serum anti-SRP antibody, including 6 with DM and 5 with CADM. Among 82 adult patients with DM/CADM, the prevalence of malignant tumors was significantly higher in the patients with anti-SRP antibody than in those without (7/9 vs. 31.5%[23/73], χ² = 7.394, P = 0.006) . The 11 patients with anti-SRP antibody had typical DM skin lesions, and their cutaneous dermatomyositis disease area and severity index (CDASI) was 18.1 ± 2.9. The prevalence of "angel wings sign" (aliform erythema on the trunk) was significantly higher in the patients with anti-SRP antibody than in those without (7/11 vs. 29.9%[20/67], Fisher′s exact test, P = 0.028) . The positive rate of antinuclear antibody was significantly higher in the patients with anti-SRP antibody than in those without (4/8 vs. 16.7%[13/78], χ² = 6.053, P = 0.014) . Magnetic resonance imaging of muscles of both thighs of the 10 patients with anti-SRP antibody (6 with DM and 4 with CADM) showed the presence of abnormal signals in the thigh muscle group in 8, swelling of the muscle group in 2, subcutaneous edema in 2, myofascial swelling in 1, and no abnormities in 2. No interstitial lung disease or myocardial involvement was observed in the patients with anti-SRP antibody. Conclusions The anti-SRP antibody-positive patients with DM/CADM showed a high prevalence of "angel wings sign" , and a high risk of malignant tumors. Early detection of the anti-SRP antibody in patients with DM/CADM is helpful to predict the occurrence of malignant tumors.

adrenocorticalcarcinoma；cortisolhypersecretion；hypokalemia；prognosis 【Objective】To analyze the prognostic determinants of adreno cortical carcinoma（ACC）inadults.【Methods】Alladult patients who were admitted to SunYat-sen Memorial Hospital，SunYat-sen University from December 2011 to March 2017 and pathologically diagnosed ACC were included in this study.Thec linical data and preoperative laboratory examinations of those patients were analyzed retrospectively. Overall survival or disease-free survival was calculated and survivalcurves were plotted by Kaplan-Meier and compared by log-rank test. Harzardratios（HRs） with their 95% confidenceintervals（CIs） were calculated by univariate and multivariate Coxregression model.【Results】The study included 20 adult patients with ACC， with a median follow-up of 13months （6~73 months）. The mean survival time of those patients was 49.2 months（6~73months），with a 1-year survival rate of 70.0%. The results of multivariate Coxregression analysis revealed that the presense of cortisol hypersecretion（HR=23.60，95%CI：2.49-223.79，P=0.006） and hypokalemia（HR=23.60，95%CI：2.49-223.79，P=0.006）were predictors of poorprognosis of ACC. Moreover，in 18 patients with completely resected ACC，the presense of hypokalemia resulted in a worse disease-free survival.【Conclusion】The presense of cortisol hypersecretion and hypokalemiaare independent risk factors associated with poorprognosis of ACC in adults.​