ObjectiveTo establish an animal model of atrial fibrillation（AF） that accurately reflects the phlegm-heat and blood stasis（TRYZ） pathogenesis in traditional Chinese medicine. MethodsForty SPF-grade SD rats were randomly assigned using a random number table to the following groups：the control group， the TRYZ+AF group，the AF group and the TRYZ group， with ten rats in each group. The TRYZ+AF and TRYZ groups underwent a high-fat diet combined with intraperitoneal lipopolysaccharide（LPS） injection to simulate the pathological alterations of TRYZ syndrome. Groups TRYZ+AF and AF were induced with acetylcholine-calcium chloride（Ach-CaCl₂） via caudal vein injection to induce AF. The control group received no intervention and was maintained under normal conditions. The modeling period lasted 3 weeks. Electrocardiography was used to assess AF episodes and duration， echocardiography evaluated left atrial dimensions and cardiac function， fully automated biochemical analyzer measured the levels of total cholesterol（TC）， triglycerides（TG）， high-density lipoprotein cholesterol（HDL-C） and low-density lipoprotein cholesterol（LDL-C）， hemoreometer analyzed the whole blood viscosity， plasma viscosity， and whole blood reduced viscosity， a coagulation analyzer assessed prothrombin time（PT）， activated partial thromboplastin time（APTT）， thrombin time（TT）， and fibrinogen（FIB）， enzyme-linked immunosorbent assay（ELISA） was used to determine the levels of C-reactive protein（CRP）， interleukin（IL）-1β， IL-6， IL-17， tumour necrosis factor（TNF）-α， matrix metalloproteinase-9（MMP-9）， galectin-3（Gal-3）， Collagen Ⅰ， and α-smooth muscle actin（α-SMA）. Hematoxylin-eosin（HE） staining and Masson's trichrome staining were used to analyze pathological changes in atrial myocardium， Western blot was employed to detect MMP-9， Collagen Ⅰ and α-SMA protein expression in myocardial tissue， real-time quantitative polymerase chain reaction（Real-time PCR） evaluated fibrous factor gene expression levels. Changes in the TRYZ syndrome were assessed via body weight， tongue color［red（R）， green（G）， and blue（B）］， and rectal temperature. Ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS） was employed to detect differential metabolites between the control group and the TRYZ+AF group. ResultsFollowing three weeks of sustained modeling， compared with the control group， rats in the TRYZ+AF and the TRYZ groups exhibited reduced body weight， dry faeces， elevated rectal temperature， dark red tongue， decreased RGB values on the tongue surface， and markedly elevated TC and LDL-C levels（P<0.05， P<0.01）. The TRYZ+AF， TRYZ， and AF groups exhibited significantly decreased TT， APTT and PT， along with markedly elevated whole blood viscosity and FIB（P<0.05， P<0.01）. Rats in the TRYZ+AF and AF groups exhibited AF rhythm， markedly decreased heart rate， prolonged RR intervals， enlarged left atrium， and significantly reduced ejection fraction and shortening fraction（P<0.05， P<0.01）. Serum levels of CRP， IL-1β， IL-6， IL-17， TNF-α， MMP-9， Gal-3， Collagen Ⅰ， and α-SMA were elevated in rats from the TRYZ+AF， TRYZ， and AF groups compared to the control group， with the most pronounced increase observed in the TRYZ+AF group（P<0.05， P<0.01）. Histopathology revealed that the collagen fiber deposition in the atrial of rats in the TRYZ+AF， TRYZ and AF groups was higher than that in the control group（P<0.05， P<0.01）. Western blot and Real-time PCR results further demonstrated that the protein and mRNA expression levels of MMP-9， Collagen Ⅰ and α-SMA in the myocardial tissue of the TRYZ+AF group were higher than those in the other three groups（P<0.05， P<0.01）. Metabolomic analysis revealed 173 differentially expressed metabolites in the TRYZ+AF group and the control group， primarily enriched in pathways such as glycerophospholipid metabolism and glycolysis/gluconeogenesis. ConclusionThis study successfully establishes a rat model of AF integrated with the TRYZ syndrome， demonstrating the pathological process where the interactions of phlegm， heat and stasis jointly trigger tremor， this provides a reliable experimental tool for in-depth research into the biological basis of this disease syndrome.

OBJECTIVE To explore the relationship between white matter damage and sleepiness,decreased sleep quality,and cognitive decline in patients with OSA.METHODS There were 55 confirmed cases of OSA diagnosed by polysomnography(PSG)from January 2018 to May 2023 were selected,with 29 non-OSA controls also diagnosed by PSG.DKI scanning and Epworth sleepiness scale(ESS),Pittsburgh sleep quality index(PSQI),and Montreal cognitive assessment(MoCA)scores were performed for all subjects.Differences in kurtosis fractional anisotropy(KFA)of various brain regions were compared between the two groups to identify differential brain regions,and pairwise correlations were analyzed between KFA reduction and apnea-hypopnea index(AHI),lowest oxygen saturation(LSaO2)and various scale scores in OSA patients.RESULTS The KFA values in right external capsule,bilateral corona radiata,bilateral superior longitudinal fasciculus,corpus callosum,posterior cingulate gyrus of OSA group were lower than control group(P<0.05).For the OSA group:The correlation between ESS scores and KFA values of right posterior corona radiata,left superior longitudinal fasciculus,body of corpus callosum,splenium of corpus callosum are all negative(r=-0.287,-0.286,-0.276,-0.449,P<0.05).The correlation between PSQI scores and KFA values of right posterior corona radiata,left posterior corona radiata,splenium of corpus callosum are all negative(r=-0.390,-0.274,-0.348,P<0.05).The correlation between MoCA scores and KFA values of right posterior corona radiata,right superior longitudinal fasciculus,left anterior corona radiata,left posterior corona radiata,left superior corona radiata,left superior longitudinal fasciculus,genu of corpus callosum,body of corpus callosum,are all positive(r=0.290,0.389,0.298,0.278,0.340,0.473,0.344,0.344,P<0.05).The correlation between visuospatial and executive function scores and AHI,LSaO2,ESS scores and KFA values of right posterior corona radiata,left superior corona radiata,left superior longitudinal fasciculus and splenium of corpus callosum are all significant(r=-0.350,0.470,-0.343,0.401,0.284,0.387,0.274,P<0.05).CONCLUSION Patients with OSA exhibit damage to the white matter in certain brain regions.The damage to the corpus callosum,posterior corona radiata,and superior longitudinal fasciculus has the greatest impact on patients'sleepiness,reduced sleep quality,and cognitive impairment.In particular,the impairment in visuospatial and executive function is closely associated with white matter damage in the corona radiata and superior longitudinal fasciculus.

Objective To investigate the expression levels of microRNA-34a(miR-34a),β-catenin and pro-grammed death receptor-1(PD-L1)in cancer tissues of patients with cervical cancer(CC)and their correla-tion with patients' prognosis.Methods A total of 83 patients with CC admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University from June 2021 to January 2024 were selected as the research objects.General data,CC tissue and adjacent normal tissue samples of all patients were collected.The mRNA expres-sion levels of miR-34a,β-catenin and PD-L1 in CC tissues and adjacent normal tissues were detected by fluo-rescence quantitative PCR and compared.The expression levels of β-catenin and PD-L1 in CC tissues and adja-cent normal tissues were detected by immunohistochemistry.Multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis in CC patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of miR-34a,β-catenin and PD-L1 expression levels in CC pa-tients with poor prognosis.Results Compared with adjacent normal tissues,the expression level of miR-34a of the CC tissues was lower,while the expression levels of β-catenin and PD-L1 were higher(P＜0.05).The positive expression rates of β-catenin and PD-L1 protein in CC tissues were higher than those of adjacent nor-mal tissues(89.16％vs.10.84％,78.31％vs.20.48％,x2=101.807,55.526,P＜0.05).There were no sig-nificant differences in age and body mass index(BMI)between the good prognosis group and the poor progno-sis group(t=1.508,1.820,both P＞0.05),while there were significant differences in International Federa-tion of Gynecology and Obstetrics(FIGO)stage and differentiation degree between the two groups(x2=8.451,9.115,both P＜0.05).Compared with the good prognosis group,the expression level of miR-34a of the poor prognosis group was lower,while the expression levels of β-catenin and PD-L1 were higher(P＜0.05).Multivariate Logistic regression analysis showed that increased expression of miR-34a was an protective factor for poor prognosis in CC patients,while the increased expression levels of β-catenin and PD-L1,Ⅱ a and Ⅱ b FIGO staging and low differentiation were independent risk factors for poor prognosis in CC patients(P＜0.05).ROC curve analysis showed that miR-34a,β-catenin and PD-L1 all had certain predictive value for the poor prognosis of CC patient,and the area under the curve(AUC)of the single detection was 0.765,0.836 and 0.797,respectively.The AUC of the combined detection was 0.914(Z=2.631,2.331,2.571,P=0.009,0.020,0.010).Conclusion The expression levels of miR-34a,β-catenin and PD-L1 mRNA affect the prognosis of CC patients.Increased expression of miR-34a is an protective factor for poor prognosis in CC patients,in-creased β-catenin and PD-L1 expressions are independent risk factors for poor prognosis in CC patients,and all three factors can be used as biomarkers to predict poor prognosis in CC patients,and the combined detection of the three has the highest prognostic value.

ObjectiveTo evaluate the efficacy and safety of acupoint application for post-stroke depression (PSD) by regulating gastrointestinal function. A secondary objective is to explore the potential mechanism underlying this approach from the perspective of gut microbiota.MethodsThis multicenter, randomized, double-blind (patients and assessors), placebo-controlled trial will enroll 80 patients with PSD, and include a 1-week run-in period, a 4-week treatment phase, and a 12-week follow-up. Eligible participants will randomly be assigned in a 1:1 ratio to either the acupoint application or placebo (non-acupoint) groups. Treatments will be administered thrice weekly for 4 weeks. The primary outcome is change in the Hamilton Rating Scale for Depression (HAMD) score. Secondary outcomes include the Beck Depression Inventory (BDI), 36-Item Short-Form Health Survey (SF-36), Barthel Index of Activities of Daily Living, Social Adaptation Self–Evaluation Scale (SASS), and gut microbiota profiling. All outcomes will be assessed at baseline (prior to treatment), during treatment (weeks 2 and 4), and during follow-up (weeks 8, 12, and 16). The Treatment Emergent Symptom Scale (TESS) will be used for evaluation throughout the 4-week treatment phase.DiscussionThe results of this study will provide important evidence supporting a novel treatment strategy for PSD that targets gastrointestinal regulation, potentially informing future clinical practice.

Objective To investigate the relationship between Klotho,insulin-like growth factor-1(IGF-1),and Irisin in the placentas of pregnant rats and the intrauterine development of fetuses.Methods Thirty SD rats were divided into the intrauterine growth restriction(IUGR)experimental animal model group(IUGR group),the macrosomia experimental animal model group(macrosomia fetal group),and the control group ac-cording to different feeding diets(low-protein diet,high-protein diet,and normal diet).All pregnant mice were subjected to laparotomy for tissue sampling on the 21st day of pregnancy.The birth weight,body length,and placental mass of fetal rats were recorded.The relative mRNA expression levels of Klotho,IGF-1,and Irisin in the placentas were detected by quantitative real-time fluorescent reverse transcription-PCR(qRT-PCR),and the correlations between various factors above were analyzed.Results Compared with the control group,the birth weight,body length and placental mass of fetal rats in the IUGR group were lower,while those in the macrosomia fetal group were higher,with statistically significant differences(P<0.05).Compared with the control group,the relative mRNA expression levels of Klotho,IGF-1,and Irisin in the IUGR group were de-creased,while those in the macrosomia fetal group were increased,with statistically significant differences(P<0.05).Correlation analysis showed that Klotho mRNA was positively correlated with the relative expres-sion levels of placental IGF-1 mRNA and Irisin mRNA,and IGF-1 mRNA were also positively correlated with the relative expression level of placental Irisin mRNA(P<0.05).Conclusion Klotho,IGF-1,and Irisin in the placenta are associated with fetal growth and possibly regulated through the Klotho/IGF-1/Irisin axis.

Objective:To evaluate the effect of dietary adjustment guided by body composition analysis on blood glucose,,blood lipids,weight gain and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods:A total of 122 GDM patients who had regular prenatal check-ups and gave birth at Wenzhou People's Hospital from May 2021 to October 2023 were selected as the research subjects and were randomly divided into Group A and Group B,with 61 cases in each group.Group A was given routine nutritional intervention with GDM,and Group B was adjusted their dietary structure based on body composition analysis.Another 50 normal pregnant women were selected as the control group.Three groups were compared for blood glucose,lipids,and body mass growth and pregnancy outcomes.Results:After intervention,the levels of FPG and 2hPG in the three groups were significantly decreased,while the levels of TC,TG,and LDL-C were significantly increased;The HbA1c levels in Group A and Group B were decreased significantly,while the HDL-C levels in the control group were significantly increased(P<0.05).After intervention,the levels of FPG,2hPG,HbA1c,TC,TG,and LDL-C in Group A were significantly higher than those in Group B and the control group(P<0.05).After intervention,the levels of FPG,TC,and LDL-C in group B were significantly higher than those in the control group(P<0.05).The predelivery body mass and increased body mass during pregnancy in Group A and Group B were significantly higher than those in the control group,while Group B was significantly lower than Group A(P<0.05).There was no significant difference in the compliance rate of body mass increase during pregnancy between the control group and group B(P>0.05),but both groups were significantly higher than group A(P<0.05).There was no significant difference in the cesarean section rate,pregnancy complications,and overall incidence of adverse perinatal outcomes between the control group and group B(P>0.05),but they were significantly lower than group A(P<0.05).Conclusion:Dietary structure adjustment guided body composition analysis can help to control blood glucose levels in GDM patients,maintain reasonable weight gain during pregnancy,reduce cesarean section rates,and reduce the risk of pregnancy complications and adverse perinatal outcomes.

Acute pancreatitis(AP)is a common digestive disorder associated with moderate to high nutritional risks,necessitating timely nutritional support.Over the past five decades,medical nutrition therapy for AP has undergone a paradigm shift,transitioning from traditional fasting based on the"pancreatic rest theory"to the current emphasis on early enteral feeding to"awaken the gut."Currently,nutritional treatment has become a cornerstone of comprehensive AP management.The European Society for Clinical Nutrition and Metabolism(ESPEN),founded in 1980,is a leading professional organization dedicated to advancing research,clinical practice,and education in clinical nutrition and metabolism.To date,ESPEN has published five evidence-based guidelines on nutritional management in pancreatic diseases.This article reviews the evolution of AP nutritional therapy as outlined in these ESPEN guidelines,highlighting key recommendations and their clinical implications.

Background and Objectives: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. Methods: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). Results: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs.62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59–32.64; p=0.01).In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Conclusions Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.

Background and Objectives: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. Methods: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). Results: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs.62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59–32.64; p=0.01).In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Conclusions Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.

Background and Objectives: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. Methods: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). Results: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs.62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59–32.64; p=0.01).In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Conclusions Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.