ObjectiveThis study aimed to investigate whether Bushen Tongluo prescription inhibits macrophage polarization by regulating the Wnt3a/β-catenin signaling pathway， thereby reducing epithelial-mesenchymal transition and excessive extracellular matrix deposition， in order to elucidate the anti-pulmonary fibrosis mechanisms of Bushen Tongluo prescription and provide a new theoretical basis for the clinical treatment of pulmonary fibrosis. MethodsFifty male Sprague-Dawley （SD） rats were randomly divided into a blank group， model group， pirfenidone group， and high- and low-dose Bushen Tongluo prescription groups. Except for the blank group， the pulmonary fibrosis model was established by intratracheal instillation of bleomycin. Intervention was initiated on day 28 after modeling. The high- and low-dose Bushen Tongluo prescription groups were administered Bushen Tongluo prescription at doses of 30.88， 15.44 g·kg^-1， respectively， by intragastric gavage. The pirfenidone group was administered pirfenidone capsules at 110 mg·kg^-1 by intragastric gavage. The blank and model groups were given an equal volume of normal saline by gavage， once daily for 90 days. After treatment， the level of transforming growth factor-β₁ （TGF-β₁） in bronchoalveolar lavage fluid （BALF） was detected by enzyme-linked immunosorbent assay （ELISA）. Morphological changes in lung tissue and the collagen volume fraction were compared. The protein distribution and expression of E-cadherin， cytokeratin 19， α-smooth muscle actin （α-SMA）， vimentin， collagen type Ⅰ （Col Ⅰ）， and collagen type Ⅲ （Col Ⅲ） in lung tissue were detected by immunohistochemistry. The protein distribution and expression of CD68， arginase-1 （Arg-1）， inducible nitric oxide synthase （iNOS）， Wnt3a， and β-catenin in lung tissue were detected by immunofluorescence. The protein expression of Wnt3a and β-catenin in lung tissue was detected by Western blot， and the mRNA expression of Wnt3a and β-catenin was detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultsCompared with the blank group， a large number of inflammatory cells infiltrated the airway walls， alveolar spaces， and interstitial tissue in the model group， with obvious fibrous tissue hyperplasia. The level of TGF-β₁ in BALF was significantly increased. The protein expression of E-cadherin and cytokeratin 19 in lung tissue was decreased， whereas the protein expression of α-SMA， Vimentin， Wnt3a， β-catenin， Col Ⅰ， and Col Ⅲ was increased. The fluorescence-positive area ratios of CD68， Arg-1， iNOS， Wnt3a， and β-catenin in lung tissue were increased. The protein and mRNA expression levels of Wnt3a and β-catenin in lung tissue were significantly increased （P<0.01）. Compared with the model group， all treatment groups showed varying degrees of improvement in inflammatory cell infiltration and fibrous tissue hyperplasia in the airway walls， alveolar spaces， and interstitial tissue， decreased TGF-β₁ levels in BALF， increased protein expression of E-cadherin and cytokeratin 19 in lung tissue， decreased protein expression of α-SMA， Vimentin， Col Ⅰ， and Col Ⅲ， decreased fluorescence-positive area ratios of CD68， Arg-1， iNOS， Wnt3a， and β-catenin in lung tissue， and decreased protein and mRNA expression levels of Wnt3a and β-catenin in lung tissue （P<0.05， P<0.01）. ConclusionBushen Tongluo prescription can improve bleomycin-induced pulmonary fibrosis in rats by inhibiting epithelial-mesenchymal transition and reducing excessive extracellular matrix deposition. The mechanism may be related to inhibition of the Wnt3a/β-catenin signaling pathway and the macrophage polarization mediated by this pathway.

ObjectiveTo explore the clinical efficacy and mechanism of Bupi Qingfei prescription （BPQF） in treating stable bronchiectasis in the patients with syndromes of lung-spleen Qi deficiency and phlegm-heat accumulation in the lungs. MethodsA randomized， double-blind， placebo-controlled trial was conducted. Patients were randomized into BPQF and placebo control （PC） groups. On the basis of conventional Western medicine treatment， the BPQF granules and placebo were respectively administered at 10 g each time， twice a day， for a course of 24 weeks. The TCM symptom scores， Quality of Life Questionnaire for Bronchiectasis （QOL-B） scores， lung function indicators， T lymphocyte subsets， level of inflammatory factors in the sputum， level of neutrophil elastase （NE） in the sputum， and occurrence of adverse reactions were observed before and after treatment in the two groups. ResultsA total of 64 patients completed the study， encompassing 32 in the BPQF group and 32 in the PC group. After treatment， the BPQF group showed decreased TCM symptom scores （P<0.01）， increased QOL-B scores （P<0.01）， and declined levels of tumor necrosis factor （TNF）-α and NE （P<0.05， P<0.01）. The PC group showed decreased TCM symptom （except spleen deficiency） scores （P<0.01）， increased the QOL-B health cognition and respiratory symptom domain scores （P<0.05， P<0.01）， and a declined TNF-α level （P<0.01）. Moreover， the BPQF group had lower TCM symptom （except chest tightness） scores （P<0.05， P<0.01）， higher QOL-B （except treatment burden） scores （P<0.05， P<0.01）， and lower levels of interleukin-6 and TNF-α （P<0.05） than the PC group. Neither group showed serious adverse reactions during the treatment process. ConclusionBPQF can ameliorate the clinical symptoms of stable bronchiectasis patients who have lung-spleen Qi deficiency or phlegm-heat accumulation in the lungs by regulating the immune balance and inhibiting airway inflammatory responses.

ObjectiveBased on the multidimensional correlation analysis framework of "disease， syndrome， formula， and medicine"， this study aims to systematically elucidate the regulatory effects of effective components in Qiangjing tablet on testosterone synthesis pathways in testicular Leydig cells under oxidative stress， providing a theoretical basis for the treatment of male infertility with traditional Chinese medicine and modern research on compounds. MethodsDisease targets for male infertility were obtained from The Human Gene Database （GeneCards， score ≥20）， the Comparative Toxicogenomics Database （CTD， score ≥150）， DrugBank （score ≥0.2）， and DisGeNET （score ≥0.2）. Targets related to the syndrome of kidney deficiency and blood stasis were acquired from the traditional Chinese medicine syndrome association database SymMap. Components of Qiangjing tablet were retrieved based on The Encyclopedia of Traditional Chinese Medicine （ETCM） database and the Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine （TCMIP）， and they were screened according to a quantitative estimate of drug-likeness （QED ≥ 0.49） and a target confidence index>0.8. Intersecting targets were taken to construct a protein-protein interaction （PPI） network using the STRING database. The network was visualized with Cytoscape software and subjected to the functional annotation of gene ontology （GO） and Kyoto encyclopedia of genes and genomes （KEGG） pathway enrichment analysis. Quality markers （Q-markers） were predicted via the ADMETlab 2.0 platform based on Lipinski's rule， Pfizer's rule， GSK's rule， and the Golden Triangle. For experimental validation， rats' testicular Leydig cells were used. Exosomes were extracted and loaded with active components via the ultrasonic method. Exosome concentration was determined using a BCA protein quantification kit. Morphology was observed using a transmission electron microscope. The particle size was analyzed with a particle size analyzer. The surface marker proteins such as cluster of differentiation 9 （CD9）， cluster of differentiation 63 （CD63）， and cluster of differentiation 81 （CD81） were identified by Western blot， and drug loading capacity was measured by high-performance liquid chromatography （HPLC）. An oxidative stress model was induced by alpha， alpha'-azodiisobutyramidine dihydrochloride （AAPH）， and Leydig cells were divided into the following groups： A control group， an AAPH group， a quercetin group （Que group）， an exosome group （Exo group）， and a QUE-loaded Exo group （Que-Exo group）. The cell viability was detected using the 3-（4，5-dimethylthiazol-2-yl）-2，5-diphenyltetrazolium bromide （MTT） thiazolyl blue assay. The reactive oxygen species （ROS） levels and mitochondrial membrane potential were measured by flow cytometry. The levels of oxidative indicators， including malondialdehyde （MDA）， superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）， catalase （CAT）， and testosterone （T）， were detected by enzyme-linked immunosorbent assay （ELISA）. The expressions of steroidogenic enzymes such as cytochrome p450 family 11 subfamily a member 1 （CYP11A1）， hydroxy-delta-5-steroid dehydrogenase， 3 beta- and steroid delta-isomerase 1 （HSD3B1）， and hydroxysteroid 17-beta dehydrogenase 3 （HSD17B3）， regulatory factors such as steroidogenic factor 1 （SF-1） and steroidogenic acute regulatory protein （StAR）， and miR-145-5p content， were detected by Western blot and real-time polymerse chain reaction （Real-time PCR）. ResultsNetwork pharmacology analysis reveals that the main active components of Qiangjing tablet for intervening in male infertility with kidney deficiency and blood stasis syndrome were Que， luteolin， etc.， with the core mechanism involving pathways such as steroid hormone biosynthesis. Experimental results show that compared with the control group， the AAPH group exhibits significantly reduced cell viability （P<0.01）， decreased mitochondrial membrane potential （P<0.01）， significantly elevated levels of ROS， MDA， and miR-145-5p （P<0.01）， significantly reduced activities of SOD， GSH-Px， and CAT， as well as reduced testosterone content （P<0.01）， and significantly downregulated protein and mRNA expressions of steroidogenic enzymes， SF-1， and StAR （P<0.01）. The above indicators were reversed in the Que and Que-Exo groups （P<0.05）. Compared with the Que group， the Que-Exo group showed more significant effects in enhancing cell viability， mitochondrial membrane potential， testosterone level， antioxidant enzyme activities， and expressions of key molecules in the steroidogenic pathway （P<0.05）. ConclusionThis study demonstrates that Que， an active component of Qiangjing tablet， inhibits oxidative stress reaction， improves mitochondrial function in Leydig cells， upregulates steroidogenic enzyme expression， and restores testosterone production. As a carrier for Que， Exo enhance its stability， delivery efficiency， and biological effect. Additionally， miR-145-5p may be closely associated with testosterone synthesis， though its precise molecular mechanism requires further exploration. By integrating traditional Chinese medicine compounds with modern scientific technology， this research expands the paths for the modernized research of traditional Chinese medicine and opens a novel therapeutic direction with translational potential for clinical intervention of male infertility.

The pathogenesis of recurrent acute exacerbations of bronchiectasis is considered to be "yang floating and yin weakness". Yin weakness refers to the depletion of the water and fire of true yin in the lower jiao （焦）， which is the root of the disease. Yang floating refers to the ministerial fire floating upward and scorching the lung metal due to the failure of true yin to nourish and constrain yang， which is the manifestation of acute exacerbations. Yin weakness and yang floating interact with each other， forming a vicious cycle of "yin depletion leading to fire floating， and floating fire in turn injuring yin"， which leads to recurrent， prolonged， and refractory acute exacerbations of bronchiectasis. Based on the pathogenesis of yang floating and yin weakness， therapeutic formulas are proposed. Yinhuo Decoction （引火汤） can be used to nourish true yin and anchor floating fire， while a combination of Qianyang Pill （潜阳丹） and Fengsui Pill （封髓丹） is applied to warm the kidneys， subdue yang， and secure true fire， and Quanzhen Yiqi Decoction （全真一气汤） is utilized to drastically supplement the primal origin and rescue both yin and yang simultaneously.

Pulmonary sarcoidosis is an immune system disease with an unclear etiology. Guided by the yang-reinforcing method， it is believed that the fundamental pathogenesis of pulmonary sarcoidosis lies in the disharmony between water and fire and the reckless movement of the ministerial fire. The failure of the spleen and stomach to maintain warmth， leading to the production of phlegm and blood stasis， is an important pathogenesis. The invasion of external pathogenic toxins， deeply penetrating into the interior， is considered a triggering factor for the disease. The treatment focuses on supplementing the yang， consolidating the kidney， drawing fire back to its source， warming the yang， benefiting the kidney， and nourishing the spleen to generate metal. It also emphasizes unblocking the yang， transforming turbidity， and eliminating phlegm and blood stasis.

Aim To evaluate the right atrial function by two-dimensional speckle tracking imaging(2D-STI)combined with real-time three-dimensional echocardiography(RT-3DE)in patients with triple vessel coronary artery disease(TVCAD)without myocardial infarction.Methods Fifty-six patients with TVCAD without myocardial infarc-tion were selected and divided into two groups according to the results of coronary angiography:28 cases with a stenosis rate of 50％～75％and 28 cases with a stenosis rate of ≥75％.In addition,30 healthy volunteers were screened as control group.RT-3DE was performed to obtain the parameters of right atrial volume(RAVmax,RAVmin and RAVp)and then calculated right atrial passive ejection fraction(RAPEF)and right atrial active ejection fraction(RAAEF),and the maxi-mum of right atrial volume index(RAVImax).2D-STI was applied to measure right atrium strain rates during systole,ear-ly diastole and late diastole(RASRs,RASRe and RASRa).Correlation between 2D-STI parameters and N-terminal pro-brain natriuretic peptide(NT-proBNP),Gensini scores were analyzed by Pearson analysis.ROC curve analysis was used to evaluate the diagnostic value of 2D-STI,RT-3DE,and their combined use for right atrial function in TVCAD patients without myocardial infarction.Results Compared with control group,RAPEF and RASRe reduced in stenosis rate of 50％～75％group,while RAAEF and RASRa increased(all P＜0.05).Compared with control group and stenosis rate of 50％～75％group,RAPEF,RASRs,RASRe and RASRa decreased,while RAVmax,RAVmin,RAVp,RAVImax and RAAEF increased in stenosis rate of ≥75％group(all P＜0.05).There was a significant correlation between 2D-STI pa-rameters and NT-proBNP and Gensini scores.The area under the curve of right atrial function in TVCAD patients without myocardial infarction was 0.9048,0.8917 and 0.9564 for 2D-STI,RT-3DE and their combined use,respectively.The diagnostic efficacy of the two methods was significantly higher when used in combination than when used alone,and 2D-STI was superior to RT-3DE.Conclusion When evaluating the right atrial function of TVCAD patients without myocardial infarction,the diagnostic efficacy of 2D-STI combined with RT-3DE is higher than that of using it alone,and 2D-STI is su-perior to RT-3DE.

Aim To evaluate the right atrial function by two-dimensional speckle tracking imaging(2D-STI)combined with real-time three-dimensional echocardiography(RT-3DE)in patients with triple vessel coronary artery disease(TVCAD)without myocardial infarction.Methods Fifty-six patients with TVCAD without myocardial infarc-tion were selected and divided into two groups according to the results of coronary angiography:28 cases with a stenosis rate of 50％～75％and 28 cases with a stenosis rate of ≥75％.In addition,30 healthy volunteers were screened as control group.RT-3DE was performed to obtain the parameters of right atrial volume(RAVmax,RAVmin and RAVp)and then calculated right atrial passive ejection fraction(RAPEF)and right atrial active ejection fraction(RAAEF),and the maxi-mum of right atrial volume index(RAVImax).2D-STI was applied to measure right atrium strain rates during systole,ear-ly diastole and late diastole(RASRs,RASRe and RASRa).Correlation between 2D-STI parameters and N-terminal pro-brain natriuretic peptide(NT-proBNP),Gensini scores were analyzed by Pearson analysis.ROC curve analysis was used to evaluate the diagnostic value of 2D-STI,RT-3DE,and their combined use for right atrial function in TVCAD patients without myocardial infarction.Results Compared with control group,RAPEF and RASRe reduced in stenosis rate of 50％～75％group,while RAAEF and RASRa increased(all P＜0.05).Compared with control group and stenosis rate of 50％～75％group,RAPEF,RASRs,RASRe and RASRa decreased,while RAVmax,RAVmin,RAVp,RAVImax and RAAEF increased in stenosis rate of ≥75％group(all P＜0.05).There was a significant correlation between 2D-STI pa-rameters and NT-proBNP and Gensini scores.The area under the curve of right atrial function in TVCAD patients without myocardial infarction was 0.9048,0.8917 and 0.9564 for 2D-STI,RT-3DE and their combined use,respectively.The diagnostic efficacy of the two methods was significantly higher when used in combination than when used alone,and 2D-STI was superior to RT-3DE.Conclusion When evaluating the right atrial function of TVCAD patients without myocardial infarction,the diagnostic efficacy of 2D-STI combined with RT-3DE is higher than that of using it alone,and 2D-STI is su-perior to RT-3DE.

Aim To evaluate the effect of hemoperfusion on carotid artery elasticity in patients undergoing hemo-dialysis using shear wave elastography(SWE).Methods Seventy-eight patients with uremia were included,and di-vided into two groups based on dialysis regimen:hemodialysis alone group and hemodialysis combined with hemoperfusion group,while 40 healthy subjects were selected as control group.Then general information,clinical data and biochemical indices were collected.The carotid intima-media thickness(IMT),carotid artery inner diameter at the end of systole(Ds),the carotid artery inner diameter at the end of diastole(Dd)and the peak systolic flow velocity(PSV)were meas-ured by conventional ultrasound.The degree of arterial wall motion(△D)and arterial stiffness coefficient(β)were cal-culated.Elasticity of intima-medial layer in the anterior carotid artery was measured by SWE,including the maximum modulus of elasticity(MEmax),mean modulus of elasticity(M Emean),minimum modulus of elasticity(MEmin).Re-sults There were no statistically significant differences in Ds,Dd,△D and PSV among the three groups(all P＞0.05).Compared with control group,the IMT,β,SWE parameters were significantly increased in the hemodialysis combined with hemoperfusion group and the hemodialysis alone group.Compared with hemodialysis alone group,the SWE parameters were significantly decreased in the hemodialysis combined with hemoperfusion group(P＜0.05),while there were no statis-tically significant differences in IMT and β(both P＞0.05).In the three groups,SWE parameters were positively correla-ted with IMT,β and LDLC(r＞0.37,all P＜0.01)and negatively correlated with HDLC(|r|＞0.24,all P＜0.05).The areas under the ROC curves of the SWE parameters were all higher than those of the conventional ultrasound parameters(all P＜0.05).Conclusion SWE can effectively assess the effect of hemoperfusion on the elasticity of carotid arteries in uremic patients undergoing hemodialysis.

Aim To evaluate the effect of hemoperfusion on carotid artery elasticity in patients undergoing hemo-dialysis using shear wave elastography(SWE).Methods Seventy-eight patients with uremia were included,and di-vided into two groups based on dialysis regimen:hemodialysis alone group and hemodialysis combined with hemoperfusion group,while 40 healthy subjects were selected as control group.Then general information,clinical data and biochemical indices were collected.The carotid intima-media thickness(IMT),carotid artery inner diameter at the end of systole(Ds),the carotid artery inner diameter at the end of diastole(Dd)and the peak systolic flow velocity(PSV)were meas-ured by conventional ultrasound.The degree of arterial wall motion(△D)and arterial stiffness coefficient(β)were cal-culated.Elasticity of intima-medial layer in the anterior carotid artery was measured by SWE,including the maximum modulus of elasticity(MEmax),mean modulus of elasticity(M Emean),minimum modulus of elasticity(MEmin).Re-sults There were no statistically significant differences in Ds,Dd,△D and PSV among the three groups(all P＞0.05).Compared with control group,the IMT,β,SWE parameters were significantly increased in the hemodialysis combined with hemoperfusion group and the hemodialysis alone group.Compared with hemodialysis alone group,the SWE parameters were significantly decreased in the hemodialysis combined with hemoperfusion group(P＜0.05),while there were no statis-tically significant differences in IMT and β(both P＞0.05).In the three groups,SWE parameters were positively correla-ted with IMT,β and LDLC(r＞0.37,all P＜0.01)and negatively correlated with HDLC(|r|＞0.24,all P＜0.05).The areas under the ROC curves of the SWE parameters were all higher than those of the conventional ultrasound parameters(all P＜0.05).Conclusion SWE can effectively assess the effect of hemoperfusion on the elasticity of carotid arteries in uremic patients undergoing hemodialysis.