ObjectiveTo investigate the possible mechanism of Jishe Qushi Capsule （脊蛇祛湿胶囊， JQC） in treating rheumatoid arthritis （RA） from the perspective of macrophage polarization mediated by neutrophil extracellular traps （NETs）. MethodsTwenty-four female SD rats were randomly divided into four groups， blank control group， model group， JQC group， and peptidylarginine deiminase 4 （PAD4） inhibitor group with 6 rats in each group. All groups but the blank control group were subjected to the induction of collagen-induced arthritis （CIA）. After successful model establishment， rats in the JQC group received intragastric administration of JQC 1.47 g/kg daily； rats in the PAD4 inhibitor group received intraperitoneal injections of the PAD4 inhibitor 4 mg/kg weekly. Rats in the blank， model， and PAD4 inhibitor groups received 2 ml of pure water daily by gavage. All treatments lasted 4 weeks. Joint lesions of each group were assessed on day 7， 14， 21， 28， and 35 after model establishment， and arthritis index （AI） scores were recorded. At 24 h after the final administration， histopathology of knee joints， including HE staining， safranin O-fast green staining， and TRAP staining， was performed. Flow cytometry was used to detect the counts of M1 and M2 macrophages in peripheral blood. ELISA was used to determine serum levels of TRACP， NETs， TNF-α， IL-1β， and iNOS. Western Blotting and qRT-PCR were used to measure MPO， NE， RANKL， OPG， and p65 protein and mRNA expression in knee cartilage tissue. ResultsCompared with the blank control group， the model group showed increased AI scores （P＜0.05）， marked synovial inflammatory infiltration， angiogenesis， and bone-cartilage destruction， increased TRAP-positive osteoclasts， increased M1 macrophages and decreased M2 macrophages， elevated serum TRACP， NETs， TNF-α， IL-1β， and iNOS （P＜0.05）， elevated MPO， NE， RANKL， and p65 protein/mRNA expression and decreased OPG protein/mRNA expression in knee cartilage tissue （P＜0.05）. Compared with the model group， the JQC group exhibited improved synovial inflammation， angiogenesis， and bone-cartilage damage， reduced AI scores on day 21， 28， and 35， decreased osteoclast counts， decreased M1 macrophages and increased M2 macrophages， reduced serum TRACP， NETs， TNF-α， IL-1β， and iNOS （P＜0.05）， decreased MPO， NE， RANKL， and p65 protein/mRNA expression and increased OPG expression （P＜0.05）. Compared with the PAD4 inhibitor group， the JQC group showed significantly lower AI scores， reduced M1 macrophages， increased M2 macrophages （P＜0.05）， reduced serum TRACP， TNF-α， IL-1β， and iNOS， decreased MPO， RANKL， and p65 expression， and increased OPG levels （P＜0.05）. ConclusionThe therapeutic mechanism of JQC for RA may involve inhibition of NETs formation， downregulation of the RANKL/NF-κB signaling pathway， and regulation of macrophage M1/M2 polarization imbalance， thereby suppressing osteoclastogenesis and inflammatory bone destruction.

OBJECTIVE To investigate the therapeutic mechanisms of electroacupuncture at"Tianshu"(ST25)and"Sanyinjiao"(SP6)acupoints combined with metformin in the treatment of type 2 diabetes mellitus(T2DM)using serum non-targeted metabolomics.METHODS Male SD rats were randomly divided into blank group,model group,metformin group,electroacupunc-ture group,and acupuncture-medicine combination(electroacupuncture combined with metformin)group.A type 2 diabetes model was established by high-fat diet combined with intraperitoneal injection of streptozotocin.The metformin group was treated with 250 mg·kg-1 metformin by gavage,the electroacupuncture group was treated with bilateral Tianshu and Sanyinjiao,the acupuncture-medicine combination group was treated with metformin by gavage combined with electroacupuncture,and the blank group and model group were treated with normal saline by gavage.All rats were treated 6 times a week for 7 weeks.After the intervention,the blood glucose level in the tail vein of the rats was measured using a blood glucose meter in the fasting state.The blood glucose levels of the rats were measured at 30,60,120,and 240 min after intraperitoneal injection of 50%glucose solution(4 mL·kg-1)to evaluate glu-cose tolerance.The serum insulin level of the rats was detected by ELISA and the insulin resistance index was calculated.The blood biochemical parameters were measured by an automatic blood biochemical analyzer.HE staining was used to evaluate the pathological conditions of the liver and pancreatic tissues of the rats.Ultra-performance liquid chromatography-mass spectrometry(UPLC-MS)technology was used for mass spectrometry detection to identify differential metabolites,and MetaboAnalyst 5.0 was used for pathway enrichment analysis.RESULTS Compared with the blank group,the fasting blood glucose,area under the glucose tolerance curve,and insulin resistance index of the model group rats were significantly increased(P<0.001),blood TP and GLB were significantly de-creased(P<0.01),AST,ALT,and ALP were significantly increased(P<0.05,P<0.01,P<0.001),and obvious inflammatory cell infiltration and pathological damage were observed in the liver and pancreas tissues;compared with the model group,the fasting blood glucose,area under the glucose tolerance curve,and insulin resistance index of the acupuncture-medicine combination group were sig-nificantly decreased(P<0.05,P<0.01,P<0.001),blood ALP was significantly decreased(P<0.01),TP and GLB were significant-ly increased(P<0.05),and the pathological damage of the liver and pancreas was significantly improved.Serum metabolomics showed that the metabolic profiles of the groups were well distinguished.Compared with the blank group,the differential metabolites in the model group were enriched in histidine metabolism,thiamine metabolism,taurine and hypotaurine metabolism,ascorbic acid and alde-hyde ester metabolism,valine,leucine and isoleucine biosynthesis pathways;compared with the model group,237 metabolites such as 3-aminoadipic acid,3-oxocyclobutanecarboxylic acid and phosphorylcholine in the acupuncture-medicine combination group were sig-nificantly reduced,and the pathways were enriched in histidine metabolism,linoleic acid metabolism,thiamine metabolism,taurine and hypotaurine metabolism,valine,leucine and isoleucine biosynthesis pathways.CONCLUSION Electroacupuncture combined with metformin can effectively improve the glucose and lipid metabolism of T2DM rats,and its potential mechanism may be related to the regulation of amino acid metabolism.

Cardiovascular disease and pneumonia are the leading causes of death in the world,and often co-exist in severely ill patients,resulting in high mortality and severe sequelae.Community-acquired pneumonia and severe viral pneumonia(such as COVID-19)can cause new or worsen heart failure,arrhythmia,myocardial infarction,myocarditis,thromboembolism and other cardiovascular events(CVE).In turn,cardiac injury can also exacerbate lung disease,leading to multiple organ failure and even death.In this paper,we reviewed the correlation the advancements in pathophysiological mechanisms,high-risk factors,and clinical risk prediction models between pneumonia and CVE.

Pulmonary arterial hypertension(PAH)is characterized by progressively elevated pulmonary artery pressure and pulmonary vascular resistance.The core pathological consequence is a significant increase in right ventricular afterload,leading to right ventricular-pulmonary arterial uncoupling,and ultimately resulting in right heart failure and death.This consensus was jointly developed by experts in the field,organized by National Center for Cardiovascular Diseases,China Specialized Alliance of Pulmonary Hypertension and National Expert Committee for Cardiovascular Diseases,Professional Committee of Right Heart and Pulmonary Vascular Diseases.The consensus focuses on the definition,classification,epidemiology,pathophysiological mechanisms,diagnosis,assessment,treatment,and management of PAH-induced right heart failure.By the integrating evidence-based medicine data and the clinical expertise of Chinese specialists,this consensus summarizes standardized evaluation and management protocols.Its goals are to enhance the diagnostic and therapeutic standards for PAH-related right heart failure and ultimately improve patients'quality of life while reducing mortality.

Objective:To report the 5-year survival outcomes and recurrence patterns of robotic total gastrectomy (RTG) for locally advanced proximal gastric cancer in order to provide more valuable long-term follow-up results for clinical practice.Methods:This was a prospective, single-arm, open-label clinical trial (FUGES-014; Clinical-Trials.gov, NCT03524287). Patients with locally advanced proximal gastric cancer who underwent RTG at Fujian Medical University Union Hospital from March 5, 2018, to February 10, 2020, were included in the analysis. To evaluate the long-term efficacy of RTG in the most objective manner possible, we performed a propensity score-matched (1∶2) comparative analysis with historical control patients who had undergone laparoscopic total gastrectomy (LTG) from the FUGES-002 study (ClinicalTrials.gov, NCT02333721) in which the 5-year disease-free survival (DFS), 5-year overall survival (OS), and recurrence patterns were compared between the two groups.Results:Prior to matching, there were 48 cases in the RTG group and 263 cases in the LTG group; patients in the LTG group had more advanced cT and pT stages ( P=0.044 and 0.006, respectively) compared to the RTG group. After matching, there were 48 cases in the RTG group and 96 cases in the LTG group; however, no statistically significant differences were observed in the baseline clinical characteristics between the two groups (all P>0.05). Both groups had a median follow-up of 72 months. The 5-year DFS rates were 75.0% (95%CI: 63.7%- 88.3%) in the RTG group and 61.4% (95%CI: 52.5%-72.0%) in the LTG group ( P=0.116). Similarly, the 5-year OS rates were 79.2% (95%CI: 68.5%-91.5%) and 64.6% (95%CI: 55.7%-74.9%) in the RTG and LTG groups, respectively ( P=0.100). Within 5 years after surgery, tumor recurrence occurred in 10 patients (20.8%) in the RTG group and 33 patients (34.4%) in the LTG group ( P=0.124), and peritoneal recurrence was the predominant pattern in both groups (8.3%[4/48] vs. 10.4%[10/96]; risk difference: -0.02, P=0.554). Gastric cancer-related death was the predominant cause of death in both groups (16.7% [8/48] vs. 31.2% [30/96]; risk difference: -0.15, P=0.064). Among patients stratified by different pathological stages, no statistically significant differences were found in DFS, OS, or recurrence rates between the RTG and LTG groups (all P>0.05). Conclusions:We find the long-term oncological outcomes of RTG for locally advanced proximal gastric cancer to be noninferior to those of LTG. RTG should therefore be considered as a valid option for standardized minimally invasive surgery for locally advanced proximal gastric cancer.

Mental state is an important part of the normal life activities of the human body, and it is also the most external expression and the most easily obtained information of the physical condition. The normal activities of the mind depend on the normal operation of the viscera, qi, and blood, and are a unified whole that prospers together and suffers together. The theory of the five-spirit-viscera in the Yellow Emperor’s Inner Classic revealed that the normal mental activities of the human body were dominated by the five internal organs, that is, the five internal organs were the body and the five spirits were the function. And it highlighted the viewpoint that the five internal organs store the spirits and are actually one. The heart governs the spirit and belongs to the four internal organs. On this basis, Synopsis of Golden Chamber used the internal organs to diagnose and treat mental diseases, integrating the theory of the five spirits into it, forming a unique method of diagnosis and treatment with the heart as the leading factor and regulating the qi and blood of the four internal organs. It identified the pathogenesis of diseases such as pathogenic crying, lily disease, and hysteria from five levels: heart deficiency and weak qi, heart-lung disharmony, heart-liver disharmony, the heart of the loss of the spleen nourishment, and disharmony between heart and kidney. The treatment was mainly to replenish the deficiency of the viscera and eliminate the pathogens, reflecting the characteristics of regulating the mind and calming the four internal organs. This unique view on diagnosis and treatment has profoundly influenced the diagnosis and treatment theories of mental illnesses by later doctors, and is of great significance to the current clinical treatment of such illnesses.

Objective:To explore the correlations of sleep quality and architecture with heart rate variability (HRV) in patients with stenoses of vertebrobasilar artery system and internal carotid artery system.Methods:A retrospective study was performed; 72 patients with stenosis or occlusion of the head and neck arteries (not resulting in cerebral infarction) admitted to Department of Neurology, Second Affiliated Hospital of Zhengzhou University from June 2023 to June 2024 were chosen, including 33 patients with moderate-to-severe stenosis or occlusion of the vertebrobasilar system (VB group) and 39 patients with moderate-to-severe stenosis or occlusion of the internal carotid artery system (ICA group). Pittsburgh sleep quality index (PSQI) and polysomnography (PSG) were used to evaluate the sleep quality and architecture, respectively; and 24-hour ambulatory electrocardiogram was used to assess the HRV. Differences in PSQI score, PSG and HRV parameters between the two groups were compared; partial correlation analysis was used to explore the correlations of HRV parameters with PSQI scores and PSG parameters; multivariate linear regression was used to analyze the independent influencing factors for HRV.Results:(1) Compared with the ICA group, the VB group exhibited significantly higher PSQI scores, spontaneous arousal index (SAI), ratio of time of stage 1 non-rapid eye movement sleep/total sleep time (T N1/T t), and apnea-hypopnea index (AHI), while significantly lower ratio of time of rapid eye movement sleep/total sleep time (T R/T t), spindle wave density in stage 2 non-rapid eye movement sleep (N2), lowest blood oxygen saturation, standard deviation of normal to normal intervals (SDNN) of all sinus beats, low-frequency power (LF), and high-frequency power (HF, P<0.05). (2) In both VB group and ICA group, SDNN was negatively correlated with PSQI score ( r=-0.461, P=0.020; r=-0.378, P=0.036). In the VB group, SDNN was negatively correlated with T N1/T t ( r=-0.467, P=0.019) and SAI ( r=-0.551, P=0.004), and positively correlated with ratio of time of stage 3 non-rapid eye movement sleep/total sleep time (T N3/T t, r=0.686, P<0.001) and spindle wave density in N2 ( r=0.518, P=0.008); LF and HF were negatively correlated with SAI ( r=-0.481, P=0.015; r=-0.564, P=0.003). In the ICA group, HF was negatively correlated with spindle wave density in N2 ( r=-0.369; P=0.041). (3) Multivariate linear regression results indicated that T N3/T t (β=0.348, P=0.018), SAI (β=-0.330, P=0.018), and spindle wave density in N2 (β=0.286, P=0.013) were independent influencing factors for Ln_SDNN in patients with moderate-to-severe stenosis or occlusion of the vertebrobasilar system. Conclusion:Patients with stenosis or occlusion of the vertebrobasilar system exhibit poorer subjective sleep quality, increased light sleep, heightened arousal, and reduced sleep stability compared with those with stenosis or occlusion of the internal carotid artery system, which may be caused by the imbalance of autonomic nerve function.

Objective:To investigate the efficacy and safety of bridging thrombectomy and direct thrombectomy in patients with acute anterior circulation large core infarction.Methods:A retrospective cross-sectional study was performed; 131 patients with acute anterior circulation large core infarction with an onset time≤ 24 hours received endovascular treatment (EVT) at Department of Intervention Neurosurgery, Nanyang Central Hospital, Xinxiang Medical University, from June 2022 to June 2024 were chosen; they were divided into bridging thrombectomy group (accepted intravenous thrombolysis [IVT] before EVT, n=55) and direct thrombectomy group ( n=76). Statistical analysis was conducted to compare the differences in efficacy and safety between the two groups. Efficacy indicators included modified Rankin scale (mRS) score 90 days after thrombectomy, and good prognosis rate 90 days after thrombectomy (mRS scores of 0-2). Safety indicators included intracranial hemorrhage (ICH) incidence within 72 hours of thrombectomy, symptomatic intracranial hemorrhage (sICH) incidence within 72 hours of thrombectomy, mortality 90 days after thrombectomy, and ratio of patients receiving decompressive craniectomy after surgery. Results:No significant difference between the direct thrombectomy group and bridging thrombectomy group was noted in terms of mRS score 90 days after thrombectomy (3 [2, 6] vs. 3 [2, 6]), good prognosis rate 90 days after thrombectomy (38.2% vs. 25.5%), ICH incidence within 72 hours of thrombectomy (30.3% vs. 40.0%), sICH incidence within 72 hours of thrombectomy (21.1% vs. 21.8%), mortality rate within 90 days of thrombectomy (28.9% vs. 25.5%), and ratio of patients receiving decompressive craniectomy after surgery (9.2% vs. 9.1%, P>0.05). Core infarction volume at 100 mL was used as grouping standard, subgroup analysis showed that when the core infarction volume was 70-100 mL and >100 mL, respectively, no significant difference in sICH incidence was noted between the bridging thrombectomy group and direct thrombectomy group ( P>0.05). Conclusion:For patients with acute anterior circulation large core infarction with an onset time≤ 24 hours, bridging thrombectomy has similar efficacy and safety as direct thrombectomy.

BACKGROUND:The individualized precise puncture approach is a new approach proposed for vertebral body augmentation in recent years,and has achieved good clinical results,but there is still a lack of relevant biomechanical research.OBJECTIVE:To investigate the biomechanical effects of individualized precise puncture vertebral augmentation on the vertebral endplate and intervertebral disc of osteoporotic vertebral compression fracture using finite element analysis method.METHODS:A total of six preoperative and postoperative models of wedge type,biconcave type,and collapse type were established using the preoperative and postoperative CT imaging data of three osteoporotic vertebral compression fracture patients who had completed individualized precise puncture vertebral augmentation.500 N moment and 10 N/m rotation moment were loaded in the vertical direction of the vertebral body to simulate the normal physiological activities of the vertebral body,including forward flexion,back extension,left bending,right bending,left rotation,and right rotation,to observe the stress changes of endplates,adjacent endplates,and intervertebral discs of different types of fractured vertebral bodies after individualized precise puncture vertebral augmentation.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)After individualized precise puncture vertebral augmentation,the maximum von Mises stress values of wedge-shaped,biconcave,and collapsed fractured vertebral endplates and adjacent vertebral endplates were reduced to a certain extent.The postoperative maximum von Mises stress value increased in the T10 inferior endplate of the superior vertebral body with wedge deformity and the L1 superior endplate of the inferior vertebral body with collapsed deformity.(3)After individualized precise puncture vertebral augmentation,the overall maximum von Mises stress value of adjacent intervertebral discs in the three finite element models decreased.(4)The results show that individualized precise puncture vertebral augmentation can reduce the maximum von Mises stress value of the endplate of wedge-shaped deformity,biconcave deformity and collapsed vertebral body to a certain extent,and diminish the risk of postoperative vertebral body re-fracture.In addition,individualized precise puncture vertebral augmentation decreases the maximum von Mises stress value of the intervertebral disc,which can theoretically alleviate intervertebral disc degeneration to a certain extent.