[Objective] : To explore the clinical characteristics and methods for syndrome differentiation prediction, as well as to construct a predictive model for Qi deficiency and blood stasis syndrome in patients with acute ischemic stroke (AIS). [Methods] : This study employed a retrospective case-control design to analyze patients with AIS who received inpatient treatment at the Neurology Department of The First Hospital of Hunan University of Chinese Medicine from January 1, 2013 to December 31, 2022. AIS patients meeting the diagnostic criteria for Qi deficiency and blood stasis syndrome were stratified into case group, while those without Qi deficiency and blood stasis syndrome were stratified into control group. The demographic characteristics (age and gender), clinical parameters [time from onset to admission, National Institutes of Health Stroke Scale (NIHSS) score, and blood pressure], past medical history, traditional Chinese medicine (TCM) diagnostic characteristics (tongue and pulse), neurological symptoms and signs, imaging findings [magnetic resonance imaging-diffusion weighted imaging (MRI-DWI)], and biochemical indicators of the two groups were collected and compared. The indicators with statistical difference (P < 0.05) in univariate analysis were included in multivariate logistic regression analysis to evaluate their predictive value for the diagnosis of Qi deficiency and blood stasis syndrome, and the predictive model was constructed by receiver operating characteristic (ROC) curve analysis. [Results] : The study included 1 035 AIS patients, with 404 cases in case group and 631 cases in control group. Compared with control group, patients in case group were significantly older, had extended onset-to-admission time, lower diastolic blood pressure, and lower NIHSS scores (P < 0.05). Case group showed lower incidence of hypertension history (P < 0.05). Regarding tongue and pulse characteristics, pale and dark tongue colors, white tongue coating, fine pulse, astringent pulse, and sinking pulse were more common in case group. Imaging examinations demonstrated higher proportions of centrum semiovale infarction, cerebral atrophy, and vertebral artery stenosis in case group (P < 0.05). Among biochemical indicators, case group showed higher proportions of elevated fasting blood glucose and glycated hemoglobin (HbA1c), while lower proportions of elevated white blood cell count, reduced hemoglobin, and reduced high-density lipoprotein cholesterol (HDL-C) (P < 0.05). Multivariate logistic regression analysis identified significant predictors for Qi deficiency and blood stasis syndrome including: fine pulse [odds ratio (OR) = 4.38], astringent pulse (OR = 3.67), superficial sensory abnormalities (OR = 1.86), centrum semiovale infarction (OR = 1.57), cerebral atrophy (OR = 1.55), vertebral artery stenosis (OR = 1.62), and elevated HbA1c (OR = 3.52). The ROC curve analysis of the comprehensive prediction model yielded an area under the curve (AUC) of 0.878 [95% confidence interval (CI) = 0.855 – 0.900]. [Conclusion] This study finds out that Qi deficiency and blood stasis syndrome represents one of the primary types of AIS. Fine pulse, astringent pulse, superficial sensory abnormalities, centrum semiovale infarction, cerebral atrophy, vertebral artery stenosis, elevated blood glucose, elevated HbA1c, pale and dark tongue colors, and white tongue coating are key objective diagnostic indicators for the syndrome differentiation of AIS with Qi deficiency and blood stasis syndrome. Based on these indicators, a syndrome differentiation prediction model has been developed, offering a more objective basis for clinical diagnosis, and help to rapidly identify this syndrome in clinical practice and reduce misdiagnosis and missed diagnosis.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective·To explore the relationship between osteoarthritis and nicotinamide metabolism-related genes using bioinformatics analysis,and identify key genes with diagnostic value and therapeutic potential.Methods·By using"Osteoarthritis"as a search term,GSE12021,GSE55235,and GSE55457 were obtained from the GEO database,with GSE55457 being used as the validation set.After removing batch effects from the GSE12021 and GSE55235 datasets,the standardized combined dataset was obtained and used as the training dataset.Differentially expressed genes(DEGs)were identified from the training dataset.All nicotinamide metabolism-related genes(NMRGs)were obtained from the GeneCards and MSigDB databases.The intersection of DEGs and NMRGs was taken to obtain nicotinamide metabolism-related differentially expressed genes(NMRDEGs).Gene set enrichment analysis(GSEA)was performed on the training dataset,while gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)analysis were performed on NMRDEGs.Key genes were selected by using least absolute shrinkage and selection operator(LASSO)and support vector machine(SVM)analysis in NMRDEGs to build an osteoarthritis diagnosis model which was validated by using the GSE55457 dataset.Single sample gene set enrichment analysis(ssGSEA)was used to analyze the immune cell infiltration type.Interactions networks and drug molecule predictions were obtained for these key genes'mRNA with the DGIdb,ENCORI,and CHIPBase databases.siRNA was used to knock down the key genes in chondrocytes,and then real-time fluorescence quantitative polymerase chain reaction(RT-qPCR)was used to detect the expression of chondrogenesis-related genes.Results·Seven NMRDEGs,including NAMPT,TIPARP,were discovered.GO and KEGG analysis enriched some signaling pathways,such as nuclear factor-κB signaling pathway and positive regulation of interleukin-1-mediated signaling pathway.GSEA enriched pathways such as Hif1 Tfpathway and syndecan 1 pathway.Key genes NPAS2,TIPARP,and NAMPT were identified through LASSO and SVM analysis,and used to construct an osteoarthritis diagnostic model.The validated results showed that the diagnostic model had high accuracy.Immune infiltration analysis results obtained by ssGSEA showed significant differences(all P<0.05)in 15 types of immune cells,including macrophages.Seven potential small molecules targeting key genes were identified,along with 19 miRNAs with the sum of upstream and downstream>10,19 transcription factors with upstream and downstream>7,and 27 RNA binding proteins with clusterNum>19.The results of RT-qPCR showed that knocking down key genes reduced the expression of chondrogenesis-related genes.Conclusion·Through bioinformatics analysis,key genes related to nicotinamide metabolism,NPAS2,TIPARP,and NAMPT,are discovered,and an osteoarthritis diagnostic model is constructed.

ObjectiveTo observe the effect of Astragali Radix combined with Angelicae Sinensis Radix on the activation of adventitial fibroblasts in the rabbit model of intimal hyperplasia and decipher the underlying mechanism. MethodClean white rabbits of the same number of males and females were selected. They were randomly assigned into a sham operation group， a model group， an Astragali Radix group （1 g·kg^-1）， an Angelicae Sinensis Radix group （1 g·kg^-1）， and Astragali Radix-Angelicae Sinensis Radix groups at the ratios of 1∶1 （Astragali Radix 1 g·kg^-1 + Angelicae Sinensis Radix 1 g·kg^-1）， 1∶5 （Astragali Radix 1 g·kg^-1 + Angelicae Sinensis Radix 5 g·kg^-1）， and 5∶1 （Astragali Radix 5 g·kg^-1 + Angelicae Sinensis Radix 1 g·kg^-1）， and an atorvastatin calcium group （5 mg·kg^-1）. The rabbit model of intimal hyperplasia was established by common carotid artery cannula combined with high-cholesterol diet. The sham operation group only underwent the separation operation and not the cannula. The sham operation group had been fed with normal diet and the other groups with high-cholesterol diet （2% cholesterol + 3% olive oil + 95% common diet） since the first day after operation. At the same time， drugs were administrated in corresponding groups， and the sham operation group and model group were administrated with distilled water （15 mL·kg^-1） for 28 days. At the end of the experiment， blood was collected from abdominal aorta， and the morphological changes of adventitia were observed by Masson staining. The expression of tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in adventitia was detected by immunohistochemical method. The expression of adventitial fibroblast marker vimentin and myofibroblast marker α-smooth muscle actin （α-SMA）， which can reflect the activation of adventitial fibroblasts， was detected by immunofluorescence double staining. Western blot was employed to determine the protein levels of transforming growth factor-β₁ （TGF-β₁）， Smad2， and p-Smad2. ResultCompared with the normal group， the modeling caused adventitial hyperplasia and up-regulated the expression of TNF-α， IL-1β， α-SMA， Vimentin， TGF-β₁， Smad2， and phosphorylation（p）-Smad2 in the injured vessels （P<0.05， P<0.01）. Compared with the model group， Astragali Radix combined with Angelicae Sinensis Radix at the ratios of 1∶1 and 5∶1 alleviated the adventitial hyperplasia and down-regulated the expression of TNF-α， IL-1β， α-SMA， Vimentin， TGF-β₁， Smad2， and p-Smad2 （P<0.05， P<0.01）. ConclusionAstragali Radix combined with Angelicae Sinensis Radix， especially at the ratios of 1∶1 and 5∶1， can ameliorate the adventitial hyperplasia in the rabbit model of intimal hyperplasia by inhibiting the transformation of adventitial fibroblasts to myofibroblasts and reducing the local inflammation of blood vessels. The mechanism may be associated with the inhibition of TGF-β₁/Smad2 signaling pathway.

ObjectiveThe functional model of six major components of Astragali Radix-Angelicae Sinensis Radix combination against the proliferation of vascular smooth muscle cells （VSMCs） was constructed by uniform design， the relationship between the compatibility of these six main components and the inhibition of VSMCs proliferation was analyzed， and the effect of the compatibility of these main components of Astragali Radix-Angelicae Sinensis Radix on the proliferation of VSMCs as well as the feasibility of uniform design test in the study of multi-component compatibility of Chinese medicines were discussed. MethodCell proliferation and toxicity assay kit （CCK-8） method was used to determine the inhibitory effect of the six components of Astragali Radix-Angelicae Sinensis Radix on platelet derived growth factor-BB （PDGF-BB）-induced VSMCs proliferation in rats and the half inhibitory concentration （IC₅₀） of each component were obtained. Six chemical components of Astragali Radix-Angelicae Sinensis Radix （formononetin， astragaloside Ⅰ， astragaloside Ⅳ， calycosin， ferulic acid and calycosin-7-O-β-D-glucoside） were taken as the independent variables X₁， X₂， X₃， X₄， X₅， X₆， respectively， and the cell proliferation inhibition rate as the dependent variable Y. U24*（24⁹） uniform design table and mathematical models （including linear and quadratic polynomial） were selected， the stepwise regression method was used to screen the variables， and the better equations were obtained in theory. The actually better relationship equations were screened by setting the different dose compatibility of these six components for verification tests. According to the purpose of the experiment， the selected regression equation was processed by data centralization， so as to compare the regression coefficients of the data centralization equation and analyze the correlation between components and efficacy. ResultThe six components of Astragali Radix-Angelicae Sinensis Radix could inhibit abnormal proliferation of VSMCs in a dose-dependent manner. IC₅₀ values of formononetin， astragaloside Ⅰ， astragaloside Ⅳ， calycosin， ferulic acid and calycosin-7-O-β-D-glucoside were 123.453， 113.184， 81.655， 141.159， 101.187， 151.016 mg·L^-1， respectively. Two superior models were selected by experimental verification， including equation 1 of Y₁=73.137 897-0.207 888X₁+0.000 508X₂²+0.000 347X₁X₆ and equation 2 of Y₂=70.038 433-0.236 665X₁+0.000 577X₂²+0.000 260X₁X₄+0.000 415X₁X₆+0.000 370X₃X₅. After data centralization， equation 2 was adjusted to Y=-1.480 260-0.146 281X₁+0.000 673X₂²+0.000 314X₁X₄+0.000 456X₁X₆+0.000 737X₃X₅， the regression coefficients showed that the astragaloside Ⅰ had a positive effect on the inhibition rate of cell proliferation， formononetin-calycosin， formononetin-calycosin-7-O-β-D-glucoside and astragaloside Ⅳ-ferulic acid had an interaction effect on the inhibition rate of cell proliferation， and the synergistic effect of astragaloside Ⅳ and ferulic acid was higher than other interaction items. ConclusionThe combination of six main components of Astragali Radix-Angelicae Sinensis Radix can inhibit the abnormal proliferation of VSMCs， and it is demonstrated that the uniform test design can be used to predict the correlation between the chemical composition of Chinese medicines with their pharmacological effects， which can provide an experimental basis for the rational use of uniform design and regression analysis to construct mathematical models to study the compatibility relationship of Chinese medicines.

The production efficiency of microbial cell factory is determined by the growth performance, product synthetic capacity, and stress resistance of the strain. Strengthening the stress resistance is the key point to improve the production efficiency of microbial cell factory. Tolerance engineering is based on the response mechanism of microbial cell factory to resist stress. Specifically, it consolidates the cell wall-cell membrane barrier to enhance the defense against stress, accelerates the stress response to improve the damage repair, and creates tolerance evolutionary tools to screen industrial microorganisms with enhanced robustness. We summarize the regulation strategies and forecast the prospects of tolerance engineering, which plays an important role in the microbial cell factories for sustainable production of natural products and bulk chemicals.
Cell Membrane ; Metabolic Engineering

Objective To observe the effects of different compatibility ratios of Astragali Radix and Angelicae Sinensis Radix on vascular intimal hyperplasia; To ascertain the effective compatibility of Astragali Radix and Angelicae Sinensis Radix for antagonizing vascular intimal hyperplasia. Methods SD rats were divided into different groups by baseline geometric design method: Astragali Radix and Angelicae Sinensis Radix different compatibility ratios groups, Astragali Radix group, Angelicae Sinensis Radixgroup, positive medicinegroup and sham-operation group. A model of intimal hyperplasia of thoracoabdominal aorta was established by balloon catheter injury in vascular endothelium of rats. Then the thoracoabdominal aorta was taken out after gavage of Astragali Radix and Angelicae Sinensis Radix with different compatibility ratios for 14 days. Bloodletting was used to take thoracoabdominal aorta. Masson staining and Morphometric methods were used to analyze the intimal hyperplasia. Results IA, IT, HRIA and HRIT increased 14 day after intimal injury. Compared with the model group, IA, IT, HRIA and HRIT in Angelicae Sinensis Radix group, Astragali Radix and Angelicae Sinensis Radix 1:2 group, Astragali Radix and Angelicae Sinensis Radix 1:5 group, Astragali Radix and Angelicae Sinensis Radix 1:1 group and Astragali Radix and Angelicae Sinensis Radix 5:1 group were lower, and the effects of Astragali Radix and Angelicae Sinensis Radix 1:1 ratio were strongest. The effects on intimal hyperplasia in Astragali Radix group and Astragali Radix and Angelicae Sinensis 2:1 group had no significant differences compared with model group. Conclusion Astragali Radix and Angelicae Sinensis can inhibit vascular intimal hyperplasia in a certain compatibility ratios, and the effects of Astragali Radix and Angelicae Sinensis Radix 1:1 on intimal hyperplasia are the best.

Aim To investigate the role of Xuefuzhuyu decoction ( XFZYD ) combined with EPC in repairing damaged vascular endothelium using traditional Chi-nese medicine way of blood circulation combined with cell therapy. Methods The repaired situation of inju-ried endothelium was observed and the effect of XFZYD on EPC was analysed after the endothelial in-juried rats were gavaged XFZYD and vena caudalis in-jected EPC. Results Compared with EPC group and XFZYD group, the XFZYD joint EPC group ’ s endo-thelial thickness was reduced significantly(P<0. 05). And there appeared more significant role in lowering triglycerides, total cholesterol and increasing HDL lev-els( P<0. 05 ) , the calcium was decreased more sig-nificantly( P <0. 05 ); vascular eNOS protein expres-sion increased significantly(P<0. 05); vascular SDF-1 expression was significantly increased. Conclusion XFZYD can promote EPC repairing damaged endotheli-um, and the mechanism may be relevant to improving the environment and promoting the EPC homing.

ObjectiveTo evaluate the feasibility and value of mini-clinical evaluation exercise (Mini-CEX) in clinical neurology practice.MethodsNinety-four interns were randomly divided into observation group and control group,students in control group were teached and managed in accordance with existing management while those in observation group were evaluated by teachers after the 1 st,2nd and 3rd week.At the end of clinical practice,all the students( including students in control group and observation group)were cross assessed by teachers based on the methods mentioned above.Results The time to complete the assessment was about 25 - 40 min.The scores of nervous system examination at the end of the training were significant different between observation group and control group and the scores of diagnosis and treatment on the basis of examination were also significant different between observation group and control group ( P ＜ 0.05 ).ConclusionThe Mini-CEX assessment and feedback to promote teaching effect is feasible in the practice process of neurology,it can make up for the deficiency of current examination.