Based on the theory of 'spleen governing the containment of blood' in The Classic of Difficult Issues （《难经》）， it is proposed that medication toxicity damaging the middle jiao （焦） and failure of the spleen to contain blood constitute the core pathogenesis of cancer therapy induced thrombocytopenia （CTIT）. It is believed that the anti-tumor drug toxicity directly hits middle jiao， leading to spleen qi depletion， impairment of transportation and transformation， and insufficiency of the source of blood production. Consequently， the vessels and collaterals are deprived of nourishment and become structurally damaged. Blood fails to be contained and stored within the vessels， resulting in extravasation beyond the vascular system. Persistent retention of drug toxicity may further cause stasis due to blood deviating from its normal pathway and gradually consume the essence. In view of this root deficiency with branch excess， it is proposed that the treatment should focus on fortifying spleen， boosting qi and containing blood， with the aim of restoring spleen and stomach transportation functions， repairing vascular damage， and recovering the spleen's blood-containing function. According to individual syndrome patterns， prescriptions may be supplemented with herbs that stabilize vessels and consolidate collaterals， remove stasis and promote regeneration， and replenish essence and nourish marrow， providing new perspectives for the prevention and treatment of CTIT with traditional Chinese medicine.

Objective To explore the regulatory effect of Lingzhu Granules on the PI3K/Akt signaling pathway in the rats with polycystic ovary syndrome(PCOS)accompanied by insulin resistance.Methods Fe-male Sprague-Dawley(SD)rats aged 3 weeks d old were selected to establish the model by using the DHEA method.The intervention treatment was administered by different doses of Lingzhu Granules and the homeostasis model as-sessment of insulin resistance(HOMA-IR)was calculated.The relative expression levels of PI3K,Akt,GSK-3β and GLUT4 mRNA in the ovaries was detected by RT-PCR.The expression levels of PI3K and Akt were detected by Western blot.Results Compared with the model control group,the rat body weight in the medium and high doses Lingzhu Granules groups was significantly reduced(P＜0.05).The fasting blood glucose,fasting insulin and HOMA-IR index in the Lingzhu Granules low,medium and high doses groups were significantly lower than those in the model control group,and the differences were statistically significant(P＜0.01).The mRNA relative expression levels of PI3K,Akt,GSK-3β and GLUT4 in the Lingzhu Granules medium and high doses groups all were higher than those in the model control group(P＜0.05).The relative expression levels of PI3K and Akt in the ovarian tissue in the Lingzhu Granules low,medium and high doses groups were higher than those in the model control group,and the differences were statistically significant(P＜0.05).Conclusion Lingzhu Granules could effectively improve the insulin resistance status of PCOS rats by enhancing the synthesis of PI3K and Akt.

Objective To analyze the causes of infection and hemorrhage in patients with malignant obstructive jaundice(MOJ)after ultrasound-guided percutaneous transhepatic biliary drainage(PTBD).Methods A total of 420 patients with MOJ after PTBD in The Third Affiliated Hospital of Naval Medical University from Jun.2023 to Sep.2024 were enrolled,and their condition after PTBD,medical histories,preoperative examinations,and other clinical data were retrospectively analyzed.Univariate and multivariate logistic regression analyses were performed to explore the risk factors for postoperative infection and hemorrhage,and receiver operating characteristic(ROC)curves were plotted.Results Univariate logistic regression analysis showed that ascites,diuretics use,repeated punctures,hepatitis B virus(HBV)DNA and preoperative hemoglobin(Hb)levels,and neutrophil count(NE)were associated with infection after PTBD(all P＜0.05).Multivariate logistic regression analysis showed that ascites,diuretic use,repeated punctures,HBV DNA and preoperative Hb levels,and NE were the independent risk factors for infection after PTBD(all P＜0.05).Six factors including ascites,diuretics use,repeated punctures,HBV DNA and preoperative Hb levels,and NE were used to establish a prediction model.The area under the ROC curve of the model for predicting infection after PTBD was 83.1％(95％confidence interval[CI]75.5％-90.7％,P＜0.001).Univariate logistic regression analysis showed that liver tissue inflammation,ascites,preoperative peritoneal drainage,diuretics use,preoperative Hb and prealbumin(PA)levels were related to bleeding after PTBD(all P＜0.05).Multivariate logistic regression analysis showed that preoperative Hb and PA levels were independent risk factors for bleeding after PTBD.Preoperative Hb and PA levels were included to establish the prediction model.The area under the curve value for predicting bleeding after PTBD was 86.3％(95％CI 80.8％-91.9％,P＜0.001).Conclusion The prediction model for infection and hemorrhage after PTBD can facilitate early preventivon and intervention measures,thereby improving surgical safety.

ObjectiveTo investigate the mechanism of action of Kaixinsan in the treatment of Alzheimer's disease （AD） based on network pharmacology， molecular docking， and animal experimental validation. MethodsThe Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） and the Encyclopedia of Traditional Chinese Medicine（ETCM） databases were used to obtain the active ingredients and targets of Kaixinsan. GeneCards， Online Mendelian Inheritance in Man（OMIM）， TTD， PharmGKB， and DrugBank databases were used to obtain the relevant targets of AD. The intersection （common targets） of the active ingredient targets of Kaixinsan and the relevant targets of AD was taken， and the network interaction analysis of the common targets was carried out in the STRING database to construct a protein-protein interaction（PPI） network. The CytoNCA plugin within Cytoscape was used to screen out the core targets， and the Metascape platform was used to perform gene ontology（GO） functional enrichment analysis and Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis. The “drug-active ingredient-target” interaction network was constructed with the help of Cytoscape 3.8.2， and AutoDock Vina was used for molecular docking. Scopolamine （SCOP） was utilized for modeling and injected intraperitoneally once daily. Thirty-two male C57/BL6 mice were randomly divided into blank control （CON） group （0.9% NaCl， n=8）， model （SCOP） group （3 mg·kg^-1·d^-1， n=8）， positive control group （3 mg·kg^-1·d^-1 of SCOP+3 mg·kg^-1·d^-1 of Donepezil， n=8）， and Kaixinsan group （3 mg·kg^-1·d^-1 of SCOP+6.5 g·kg^-1·d^-1 of Kaixinsan， n=8）. Mice in each group were administered with 0.9% NaCl， Kaixinsan， or Donepezil by gavage twice a day for 14 days. Morris water maze experiment was used to observe the learning memory ability of mice. Hematoxylin-eosin （HE） staining method was used to observe the pathological changes in the CA1 area of the mouse hippocampus. Enzyme linked immunosorbent assay（ELISA） was used to determine the serum acetylcholine （ACh） and acetylcholinesterase （AChE） contents of mice. Western blot method was used to detect the protein expression levels of signal transducer and activator of transcription 3（STAT3） and nuclear transcription factor（NF）-κB p65 in the hippocampus of mice. ResultsA total of 73 active ingredients of Kaixinsan were obtained， and 578 potential targets （common targets） of Kaixinsan for the treatment of AD were screened out. Key active ingredients included kaempferol， gijugliflozin， etc.. Potential core targets were STAT3， NF-κB p65， et al. GO functional enrichment analysis obtained 3 124 biological functions， 254 cellular building blocks， and 461 molecular functions. KEGG pathway enrichment obtained 248 pathways， mainly involving cancer-related pathways， TRP pathway， cyclic adenosine monophosphate（cAMP） pathway， and NF-κB pathway. Molecular docking showed that the binding of the key active ingredients to the target targets was more stable. Morris water maze experiment indicated that Kaixinsan could improve the learning memory ability of SCOP-induced mice. HE staining and ELISA results showed that Kaixinsan had an ameliorating effect on central nerve injury in mice. Western blot test indicated that Kaixinsan had a down-regulating effect on the levels of NF-κB p65 phosphorylation and STAT3 phosphorylation in the hippocampal tissue of mice in the SCOP model. ConclusionKaixinsan can improve the cognitive impairment function in SCOP model mice and may reduce hippocampal neuronal damage and thus play a therapeutic role in the treatment of AD by regulating NF-κB p65， STAT3， and other targets involved in the NF-κB signaling pathway.

Objective To observe the effect of Kaixin Powder on neuroinflammation in APP/PS1 mice by regulating WDFY1/TLR4/NF-κB signaling pathway;To explore its mechanism of intervening in Alzheimer disease(AD).Methods APP/PS1 transgenic mice were randomly divided into model group,donepezil hydrochloride group(0.66 mg/kg),and Kaixin Powder low-,medium-and high-dosage groups(1.625,3.25,6.5 g/kg),C57BL/6J mice were set as blank control group,with 8 mice in each group,and corresponding drug intervention was given to medicaction group for 24 weeks.Morris water maze,Y maze and novel object recognition experiments were conducted to assess the cognitive function and learning and memory abilities of mice,immunohistochemical staining was used to detect the deposition of β-amyloid protein(Aβ)in hippocampus,the morphology and Nissl bodies of hippocampal CA1 neurons were observed using HE staining and Nissl staining,ELISA was used to detect the serum contents of interleukin(IL)-6,IL-17,IL-1β and tumor necrosis factor-α(TNF-α),Western blot was used to detect the protein expression of calcium-binding adapter molecule 1(Iba1),glial fibrillary acidic protein(GFAP),WDFY1,Toll like receptor 4(TLR4),Toll like receptor associated molecule(TRAM),TIR domain adapter protein(TRIF),NF-κB p65 and p-NF-κB p65 in hippocampal tissue,RT-qPCR was used to detect the mRNA expression of WDFY1,TLR4,TRAM,TRIF and NF-κB p65 in hippocampal tissue.Results Compared with the blank control group,the model group had significantly prolonged escape latency,reduced platform crossings,decreased autonomous reaction alternation rate and relative recognition index(P<0.05,P<0.01),with increased deposition of Aβ in hippocampal tissue(P<0.01),damaged morphological structure of neurons,reduced number of neurons and Nissl bodies,the serum contents of IL-6,IL-17,IL-1β and TNF-α significantly increased,the expression of Iba1,GFAP,WDFY1,TLR4,TRAM,TRIF,p-NF-κB p65 protein and WDFY1,TLR4,TRAM,TRIF mRNA in hippocampal tissue significantly increased(P<0.01).Compared with the model group,Kaixin Powder groups and donepezil hydrochloride group had significantly shortened escape latency and increased platform crossings,autonomous reaction alternation rate and relative recognition index(P<0.05,P<0.01),hippocampal Aβ deposition reduced in Kaixin Powder medium-,high-dosage groups and donepezil hydrochloride group,the morphological structure of neurons recovered,the number of neurons and Nissl bodies increased,the serum contents of IL-6,IL-17,IL-1β and TNF-α significantly decreased(P<0.05,P<0.01),and the protein expression of Iba1,GFAP,WDFY1,TLR4,TRAM,TRIF,p-NF-κB p65 and the mRNA expressions of WDFY1,TLR4,TRAM and TRIF in hippocampal tissue significantly decreased(P<0.05,P<0.01).Conclusion Kaixin Powder can improve cognitive function and learning and memory abilities in AD model mice,alleviate hippocampal neuron damage and Aβ deposition,inhibit the activation of microglia and astrocytes,and thereby reduce serum inflammatory cytokine release.Its mechanism may be related to regulating the WDFY1/TLR4/NF-κB signaling pathway to inhibit neuroinflammation.

Objective To investigate the mechanism of action and potential biomarkers of Jiangzhi Qingshen capsules in the treatment of dyslipidaemia based on clinical lipid metabolomics.Methods 30 patients with dyslipidaemia from Zhengzhou Hospital of Chinese Medicine were collected as the test group,and their lipid levels before and after taking Jiang Zhi Qing Shen capsule for 12 weeks were compared.Another 30 healthy patients were enrolled in the physical examination department of Zhengzhou Hospital of Chinese Medicine,and metabolomics investigation was carried out on plasma samples of the test group before and after the treatment as well as those of the healthy patients by LC-MS/MS technology.The differences between the groups were compared by multivariate statistical analysis,and the potential biomarkers were identified by HMDB and lipidblast databases,so as to clarify the possible pathways and targets for the treatment of mild dyslipidaemia by Jiangzhi Qingshen capsules.Results Jiangzhi Qingshen capsules could improve patients' blood lipid level,BMI and abdominal circumference significantly(P<0.05).And metabolomics results showed that 29 lipid metabolites in the plasma of the treated patients were dialled back,which involved cholesterol metabolism,fat digestion and absorption,glycerol-phospholipid metabolism and other biological processes.Conclusion The efficacy of Jiangzhi Qingshen capsules in treating dyslipidaemia was confirmed,and its mechanism of action might be related to the regulation of lipid metabolism.Metabolites such as acylcarnitine(Acar),phosphatidylethanolamine(PE)and phosphatidylcholine(PC)were expected to be used as the biomarkers of dyslipidaemia,so as to provide objective scientific basis for the lipid-lowering capsule,and to facilitate the promotion of its application.

Objective:To observe the therapeutic effects of catheter balloon dilation and high-intensity Shaker training on cri-copharyngeal achalasia after brainstem stroke and the effect on post-stroke aspiration pneumonia.Method:Fifty patients with swallowing disorders after brainstem stroke admitted to Yangfangdian Hospital and Wangjing Hospital between July 2022 and December 2022 were selected for this non-blinded clinical trial.The pa-tients were divided into the control group(n=25)and the experimental group(n=25)according to the order of ad-mission and receipt of balloon dilation.The control group was treated with conventional swallowing therapy and increased the intensity of Shaker training,while the experimental group was treated with additional transoral bal-loon dilatation.The changes of swallowing function and incidence of aspiration pneumonia were compared using videofluoroscopic swallowing study(VFSS),the standard swallowing function assessment scale(SSA),Rosenbek infiltration/misaspiration scale,feeding function and the incidence of aspiration pneumonia.The self-assessment de-pression scale(SDS)and anxiety self-assessment anxiety scale(SAS)were used to assess the changes of pa-tients'psychological status.Result:There was no statistically significant differences in swallowing function and psychological status between the two groups before treatment(P>0.05).After 8 weeks of treatment,both groups showed improvement in SSA,VFSS and Rosenbek scores(P<0.05),and significant reductions in SAS and SDS,with significant improvement in feeding function.The improvement in swallowing and psychological status of both groups was better than pre-treatment,with significantly higher in the experimental group than the control group(P<0.05).Conclusion:Both the rehabilitation training method of swallowing with increasing the intensity of Shaker training and balloon dilation are effective in the recovery of swallowing disorder,but the combined treatment is more ef-fective.Both group showed improvements in Rosenbek score and reduced incidence of aspiration after treatment,indicating that the rehabilitation training with increasing intensity of Shaker training and balloon dilation can effec-tively reduce the incidence of aspiration pneumonia,and the combined treatment was more effective.

Objective To investigate the clinical efficacy of the traditional Chinese medicine(TCM)throat opening and brightening method in treating unilateral vocal cord paralysis(UVCP).Methods Sixty patients with UVCP were prospectively collected and randomly assigned to two groups:the Chinese herbal medicine group(trea-ted with Buyang Huanwu Decoction,n=30)and the throat opening and brightening method group(treated with TCM throat opening and brightening method,n=30).The clinical studies that had utilized injection laryngoplasty for the treatment of UVCP(historical control group).Evaluation indicators included the voice handicap index-10(VHI-10),GRBAS-G,objective acoustic measurements of voice(vocal intensity,F0,shimmer,jitter,HNR),and aerodynamic measurements(maximum phonation time,MPT).Results Before treatment,no significant differences were observed between the two groups in all the evaluation indicators(P＞0.05).Post-treatment,the throat open-ing and brightening method group demonstrated significant improvements in VHI-10,GRBAS-G,shimmer,jitter,HNR,and MPT compared to pre-treatment values(P＜0.01),and these improvements were superior to those in the Chinese herbal medicine group.Pre-treatment VHI-10,GRBAS-G,and shimmer scores in the throat opening and brightening method group were significantly higher than those in the historical literature group(P＜0.01).Af-ter treatment,no significant differences were noted in any assessed parameters between the two groups(P＞0.05).Conclusion The TCM throat opening and brightening method significantly enhances phonatory function and quality of life in patients with UVCP,showing comparable efficacy to injection laryngoplasty.

AIM:To analyze the influencing factors of visual outcome after vitrectomy for polypoidal choroidal vasculopathy(PCV)combined with vitreous hemorrhage and establish a predictive model.METHODS: A retrospective analysis was conducted on the clinical data of 129 cases(129 eyes)of patients who underwent vitrectomy for PCV combined with vitreous hemorrhage from June 2021 to January 2024 in our hospital. They were divided into elevated group(71 eyes)and non-elevated group(58 eyes)according to visual outcome at early posoperative stage(within 24 mo). Another 30 cases(30 eyes)of PCV with vitreous hemorrhage undergoing vitrectomy were selected as external validation data. The predictive value of the model for the postoperative visual outcomes of both internal and external populations was evaluated.RESULTS: The non-elevated group had a higher proportion of patients aged ≥60 years, diabetes, continuous abnormalities of the ellipsoid zone(EZ)during surgery, bleeding involving the macular fovea, and postoperative retinal scar formation than the elevated group were independent factors affecting postoperative visual acuity(all P<0.05). The AUC of the predictive model for predicting the postoperative visual outcomes of internal and external populations was 0.824(95%CI: 0.750-0.898)and 0.809(95%CI: 0.723-0.865), respectively.CONCLUSION:Patients aged ≥60 years, diabetes, intraoperative continuous abnormalities of EZ, bleeding involving the macular fovea, and postoperative retinal scar formation are influencing factors for visual outcome after vitrectomy in patients with PCV combined with vitreous hemorrhage. A predictive model based on those factors has been established, which has a certain predictive value for postoperative visual outcome.

Objective:To enhance the understanding of clinical doctors on the concurrence of Sj?gren′s syndrome (SS) and myasthenia gravis (MG), provide reference forclinical diagnosis and treatment.Methods:The medical record of SS、MG patient Taian Central hospital in october 2021 was reviewed and a retrospective analysis was conducted. Based on the key words, the main databases domestic and abroad from Jan 1973 to April 2024. The cases reported in the literature were searched out and merged with our case and analyzed by SPSS 27.0. The measurement data of normal distribution were expressed by mean standard deviation ± s, and the measurement data of abnormal distribution were expressed by M( Q1, Q3). Counting data were expressed as examples and percentages (%) . Results:Twenty-one patients with SS complicated with MG were reviewed. Among them, 19(90.5%) patients were female. The average age was (47.6 ± 3.1) years, and the median time from onset to diagnosis was 24 (11, 78) months. There were 11 patients (52.4%) with myasthenia gravis as the initial presentation. The main clinical manifestations of patients with myasthenia muscle fatigue (80.9%, 17/21), gravis include fatigue ptosis (71.4%, 15/21), diplopia, blurred vision (57.1%, 12/21), dysphagia (33.3%, 7/21), joint pain (33.3%, 7/21), odysarthria, and unclear speech (23.8%, 5/21), hair loss (14.3%, 3/21), and swelling of the excocrine glands(9.5%, 2/21). Eighteen patients (85.7%, 18/21) showed positive anti acetylcholine receptor antibodies. Sixteen patients (76.2%) were positive for ANA, and 14 patients (66.8%) were positive for anti SSA or (and) anti SSB antibodies. Four patients (19.0%) also had other autoimmune diseases (Hashimoto′s thyroiditis, rheumatoid arthritis, optic neuritis). In terms of treatment, cholinesterase inhibitors were the most common treatment measure, applied to 18 patients (85.7%), followed by glucocorticoid therapy, and applied to 14 patients (66.8%). In addition, 7 patients (33.3%) received immunosuppressive agents therapy, 5 patients (23.8%) underwent thymectomy, 2 patients (9.5%) received intravenous human immunoglobulin injection, and 1 patient (4.8%) underwent plasma exchange. All patients showed improvement after treatment.Conclusion:SS and MG are both autoimmune diseases, and their coexistence is rare. Clinicans should be aware of this rare association. Early diagnosis is crucial for the treatment and prognosis of patients,and requiresa comprehensive assessment of clinical symptoms, laboratory tests, and auto-antibody test results.