Traditional Chinese medicine （TCM）， through its multi-target and systematic regulatory effects， has demonstrated unique advantages in the treatment of gastric precancerous lesions （GPL）. At present， TCM theoretical research on GPL is mainly reflected in three aspects， the integration of macroscopic syndrome differentiation， the inflammation-carcinoma transformation mechanism， as well as the systematization and scientization of theoretical inheritance from famous TCM practitioners. High-quality evidence-based research findings serve as the foundation for clinical practice guidelines on GPL， and TCM has gained international academic recognition in the field of GPL prevention and treatment. Research on TCM mechanisms has yielded a series of important outcomes in the aspects of signaling pathways， gene expression regulation， cellular epigenetics， histone modification， and intestinal microecology. It is proposed that future research on GPL should focus on four key directions， establishing multi-omics data， exploring targeted intervention strategies on key regulatory nodes， advancing the standardization process of integrated traditional Chinese and western medicine prevention and treatment technologies， and constructing stratified screening and intervention platforms. The in-depth integration of TCM microcosmic mechanism of action with its macroscopic syndrome differentiation and treatment system， coupled with interdisciplinary research， will provide valuable references for the clinical treatment and scientific research of GPL.

Objective:To investigate the anti-inflammatory effects of Duhuo Jisheng Decoction on type Ⅱ collagen emulsion induced arthritis (CIA) model rats from the perspective of M1/M2 macrophage balance mediated development of rheumatoid arthritis.Methods:SD rats were divided into a normal group of 8 and a model group of 32. The CIA model was established using collagen antibody induction method for modeling. The successfully modeled rats were randomly divided into model group, methotrexate group, and Duhuo Jisheng Decoction medium- and high-dosage groups using a random number table method, with 8 rats in each group. Duhuo Jisheng Decoction medium- and high-dosage groups were orally administered with Duhuo Jisheng Decoction at dosages of 13.5 and 27.0 g/kg, once a day; methotrexate group received oral administration of 2.0 mg/kg methotrexate twice a week; normal group and model group were given equal volumes of physiological saline by gavage once a day for 28 consecutive days. The general condition of each group of rats was observed, the degree of swelling in the right knee joint was measured, and the arthritis index was scored; HE was used to observe pathological changes in synovial tissue; immunofluorescence was used to detect the expressions of markers CD86 and CD206 in synovial macrophages; Real time PCR was used to detect the mRNA levels of IL-6, TNF-α, IL-10, and TGF-β in synovial tissue.Results:Duhuo Jisheng Decoction could significantly improve the mental state of the rats and reduced the swelling of the knee joints and the arthritis index ( P<0.01). Compared with the model group, the cartilage structure in the knees of rats in the Duhuo Jisheng Decoction group was more intact and clearer. The expression level of the M1 macrophage marker CD86 significantly decreased, and the expression level of the M2 macrophage marker CD206 significantly increased; the mRNA expressions of IL-6 and TNF-α in the knee joint synovial tissue were significantly reduced ( P<0.05), while IL-10 and TGF-β levels significantly increased ( P<0.05). Conclusion:Duhuo Jisheng Decoction may promote macrophage polarization towards M2 type, thereby achieving M1/M2 macrophage balance, alleviating inflammatory response in rheumatoid arthritis rats, and exerting therapeutic effects on rheumatoid arthritis.

Objective:To investigate the therapeutic value of visual endoscopic retrograde appendicitis therapy (vERAT) in pediatric patients with acute suppurative appendicitis (ASA).Methods:This was a retrospective cohort study. A total of 55 ASA patients who underwent vERAT at the Pediatric Department of the Tangdu Hospital of Air Force Medical University between November 2023 and January 2025 were selected and divided into groups based on the presence or absence of fecaliths: fecalith group and non-fecalith group. The baseline characteristics, initial treatment success rates, treatment costs, hospital stay duration, procedure time, and recurrence rates between two groups were compared. Mann-Whitney U test and χ2 test were used to evaluate group differences. Results:A total of 55 ASA patients were enrolled, including 38 males and 17 females, with the age of 11.2 (9.2, 13.1) years. Based on the presence of fecaliths, patients were divided into two groups: fecalith group (32 cases) and non-fecalith group (23 cases). No statistically significant differences were observed between the two groups in terms of age, gender, duration of abdominal pain, white blood cell count, neutrophil percentage, diameter of appendix, thickness of appendix clinical symptoms or signs (all P>0.05). The initial treatment success rates were 91% (29/32) in fecalith group and 96% (22/23) in non-fecalith group, with no statistically significant difference ( P=0.632). However, significant differences were noted in stent placement ( χ2=5.85, P=0.026) and procedure time ( Z=4.75, P<0.001). The follow-up duration time was 6.0 (2.0, 12.0) and 7.0 (2.0, 8.5) months for the fecalith and non-fecalith groups, respectively, with no significant difference ( Z=0.05, P=0.962). The recurrence rates were 14% (4/29) in fecalith group and 5% (1/22) in non-fecalith group, with no statistically significant difference ( P=0.375). Conclusions:vERAT can safely and effectively treat pediatric ASA, regardless of the presence or absence of fecaliths. It can provide a new treatment option for ASA.

Objective:To analyze the clinical features of children with infection-related eosinophilic lung diseases (ELD) caused by common respiratory pathogens.Methods:A retrospective cohort study was conducted. The clinical features, auxiliary examinations, treatments, and prognoses of 134 children with infection-related ELD caused by common respiratory pathogens at Yuying Children′s Hospital from January 2014 to June 2024 were collected. Participants were divided into the mild and severe groups based on whether the proportion of eosinophils in bronchoalveolar lavage fluid (BALF) exceeded 0.25. Chi-square test or Fisher exact test was used to analyze the differences between the two groups, and Logistic regression was performed to examine the correlation between BALF eosinophilia and the clinical outcomes.Results:Among the 134 children, 73 were males and 61 were females, with an age of 6.9 (4.6, 8.8) years on admission. A total of 154 pathogen detections were recorded, including 116 cases (75.3%) of Mycoplasma pneumoniae, 8 cases (5.2%) of influenza A virus, 6 cases (3.9%) of Streptococcus pneumoniae, and 6 cases (3.9%) of Chlamydia pneumoniae, among others. The percentage of eosinophils in the BALF of all children was 0.10 (0.07, 0.15). There were 117 cases in the mild group and 17 cases in the severe group. Compared with the mild group, significantly greater proportion of children in the severe group presented dyspnea (10/17 vs. 17.1% (20/117)), wheezing (7/17 vs. 8.5% (10/117)), respiratory failure (8/17 vs. 7.7% (9/117)), single lobe ≥2/3 consolidation (7/17 vs. 12.8% (15/117)), atelectasis (7/17 vs. 12.0% (14/117)), pleural effusion (7/17 vs. 16.2% (19/117)), plastic bronchiolitis (4/17 vs. 4.3% (5/117)), and systemic corticosteroid prescription (14/17 vs. 51.3% (60/117)) (all P<0.05). Univariate Logistic regression analysis revealed that severe eosinophilia in BALF was significantly associated with an elevated risk of respiratory failure ( OR=10.67, 95% CI 3.31-34.38, P<0.001), single lobe ≥2/3 consolidation ( OR=4.76, 95% CI 1.57-14.41, P=0.006), atelectasis ( OR=5.15, 95% CI 1.69-15.72, P=0.004), pleural effusion ( OR=3.61, 95% CI 1.22-10.67, P=0.020), and plastic bronchitis ( OR=6.89, 95% CI 1.64-28.94, P=0.008). Among the 126 children who were followed up, 106 cases (84.1%) were cured, 20 cases (15.9%) improved, and no relapses or deaths occurred. Conclusions:Mycoplasma pneumoniae and influenza A virus are common pathogens in children with infection-related ELD and the percentage of eosinophils in BALF is mildly increased, and the severe cases exhibit more severe clinical features and more significant pulmonary abnormalities, such as lobar consolidation and lung atelectasis. The prognosis is generally favorable.

OBJECTIVE To systematically analyze the functional system and construction requirements for infection prevention and control('infection control system'in short)in medical institutions so as to facilitate the effective,standardized and practical construction of the infection control system.METHODS The questionnaires were de-signed based on the relevant criteria and literatures that were released in China with the combination of expect con-sultant and were distributed to experts or professionals involving multiple fields such as hospital infection manage-ment,clinical medical treatment and information technology.The questionnaires were recycled,summarized and analyzed.RESULTS The list of functions of the infection control system(consultative draft)was formulated after review of literatures and expert consultation,including fundamental functions such as data management,case sur-veillance and intervention feedback as well as the advanced functions like target surveillance,occupational protec-tion and interconnection.The surveyed subjects agreed unanimously after the questionnaire survey that all of the function modules and elements enlisted were important,the average score of importance was more than 4 points,the score of coefficient of variable(CV)for importance of the function modules was less than 0.25,indicating that there was high consistency in the opinions among the surveyed subjects.The element of tracing and epidemiologi-cal survey function was adopted and added according to the feedback suggestions from some of the subjects;two function elements including data query and clinical interaction were revised,and the list of function requirements for the infection control systems was finally defined.CONCLUSION The requirements for functions of the infection control system that are determined in the study can provide important bases and data support for the research and standardized development of future infection control system.

Objective:To investigate the changes of the epidemiology and clinical characteristics of human metapneumovirus (hMPV) among children with acute lower respiratory tract infection (ALRTI) before and after the discontinuation of non-pharmaceutical interventions (NPI) during coronavirus disease 2019 epidemic.Methods:This was a retrospective cohort study. Children hospitalized at The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University between January 2021 and December 2023, who were diagnosed with ALRTI by nasopharyngeal secretion testing for respiratory pathogens nucleic acid were enrolled. Clinical and laboratory data were collected. Children admitted between January 1, 2021 and January 7, 2023 were classified as the pre-NPI withdrawal group (abbreviated as pre-withdrawal group), while those admitted from January 8, 2023 afterward were classified as the post-NPI withdrawal group (abbreviated as post-withdrawal group). Nasopharyngeal secretions from the enrolled children were tested for 13 respiratory pathogens using polymerase chain reaction-capillary electrophoresis fragment analysis, and bacterial cultures were also performed. Statistical analyses were performed using the Mann-Whitney U test or chi-square test. Results:A total of 30 855 ALRTI cases were enrolled, with 1 679 of hMPV-positive. In the pre-withdrawal group, there were 861 cases with an age of onset of 2.0(1.0, 3.0) years, and the highest proportion was in the 1 to <3 years age group, accounting for 35.3%(304/861). In the post-withdrawal group, there were 818 cases with an age of onset of 3.0(2.0, 4.0) years, and the highest proportion was in the 3 to <5 years age group, accounting for 39.2%(321/818).The age of onset in the post-withdrawal group was significantly older than that in the pre-withdrawal group ( Z=7.69, P<0.001) .The hMPV detection rate was higher in the pre-withdrawal group than that in post-withdrawal group (5.75%(861/14 984) vs 5.15%(818/15 871); χ2=5.25, P=0.022). In the pre-withdrawal group, the epidemic peaks occurred in winter and spring, with the highest rates in January 2022(25.2%(224/890)) and March 2022 (21.6%(186/860)). In the post-withdrawal group, the epidemic peak shifted to spring and summer, and the detection rate became increased since April 2023(10.8%(136/1 258)). The post-withdrawal group showed lower rates of wheezing, shortness of breath, cyanosis, respiratory support, severe pneumonia, intensive care unit admission, and shorter hospital stays compared to the pre-withdrawal group ( χ2=69.09, 31.63, 12.97, 57.96, 55.73, 5.48 and Z=7.11, respectively, all P< 0.05).In the pre-withdrawal group, 412 cases (47.9%(412/861)) had other pathogens detected, compared to 445 cases (54.4%(445/181)) in the post-withdrawal group, indicating a significantly higher rate of co-infections in the post-withdrawal group ( χ2=7.20, P<0.05). The most commonly detected pathogens in both groups were Mycoplasma pneumoniae (MP), rhinovirus, and Streptococcus pneumoniae. However, the post-withdrawal group showed significantly higher detection rates of MP and influenza virus, but lower bacterial detection rates compared to the pre-withdrawal group ( χ2=39.41, 9.70, 5.63, respectively, all P<0.05). The detection rate of Haemophilus influenzae was 2.1%(17/818) in the post-withdrawal group which lower than that (6.7%(58/861)) in the pre-withdrawal group, and the difference was statistically significant ( χ2=21.32, P<0.001). Conclusions:In 2023, following the withdrawal of NPI, the epidemic peak of hMPV in Wenzhou area is delayed to spring and summer. The age of children with hMPV-associated ALRTI increases, with the majority being 3 to <5 years old. The overall severity of the disease decreases. However, the detection of mixed pathogens increases, with MP being the most common, while bacterial detection decreases.

Objective To explore the mechanism of Bushen Zhupai Decoction in treating ovarian fibrosis in polycystic ovary syndrome(PCOS)model rats based on IL-17/TRAF6/NF-κB signaling pathway.Methods Totally 60 SPF grade female SD rats were randomly divided into blank group,model group,Yousiyue group and TCM low-,medium-and high-dosage groups,with 10 rats in each group.The PCOS model was replicated by gavage of 1 mg/kg letrozole for 21 days.The Yousiyue group was given a 10 mg/kg solution of drospirenone ethinylestradiol tablets by gavage,TCM low-,medium-and high-dosage groups were given 8.82,17.64 and 35.28 g/kg of Bushen Zhupai Decoction by gavage,once a day for 28 consecutive days.HE and Masson staining were used to observe the morphology of ovarian tissue and ovarian fibrosis,the contents of serum IL-17,IL-18 and IL-1β were detected by ELISA,the mRNA expression of IL-17,TRAF6,NF-κB p65 and TGF-β1 in ovarian tissue were determined by RT-qPCR,the protein expression of TRAF6,NF-κB p65,TGF-β1,α-SMA,E-cadherin and the positive expression of IL-17RA,TRAF6,NF-κB p65,TGF-β1 and α-SMA in ovarian tissue were detected by Western blot and immunohistochemical staining respectively.Results Compared with the blank group,the body mass,ovarian mass and ovarian index significantly increased of rats in model group,with follicular cystic dilation,thinning of granulosa cell layer,and significant increase in fibrosis positive range(P<0.01),the serum contents of IL-17,IL-18 and IL-1β significantly increased(P<0.01),the expressions of IL-17,TRAF6,NF-κB p65,TGF-β1 mRNA and IL-17RA,TRAF6,NF-κB p65,TGF-β1 and α-SMA proteins significantly increased(P<0.01,P<0.05),the expression of E-cadherin protein significantly decreased(P<0.01).Compared with the model group,the ovarian index of rats in Yousiyue group and TCM medium-and high-dosage groups significantly decreased(P<0.01,P<0.05),the rats in TCM high-dosage group showed dominant follicles,increased thickness of granulosa cell layer,and significantly reduced fibrosis positive range(P<0.01),the serum contents of IL-17,IL-18 and IL-1β significantly decreased in Yousiyue group and TCM low-,medium-and high-dosage groups(P<0.01),the mRNA expressions of IL-17,TRAF6,NF-κB p65,TGF-β1,and the protein expressions of IL-17RA,TRAF6,NF-κB p65,TGF-β1 and α-SMA in ovarian tissue significantly decreaed in TCM high-dosage group(P<0.01,P<0.05),the expression of E-cadherin protein significantly increased(P<0.01).Conclusion Bushen Zhupai Decoction can decrease the body mass,improve the ovarian index,decrease the expressions of inflammatory factors and improve the status of ovarian fibrosis in PCOS rats.The mechanism may be related to the regulation of IL-17/TRAF6/NF-κB signaling pathway.

Objective:To investigate the clinical significance of prenatal screening and genetic analysis in the diagnosis of fetal aberrant right subclavian artery(ARSA).Methods:The ultrasonographic features of ARSA fetu-ses detected by prenatal ultrasound at the University of Hong Kong-Shenzhen Hospital from October 2017 to March 2022 were retrospectively analyzed.The fetuses were divided into isolated ARSA group and complicated ARSA group.Their genetic analysis results and pregnancy outcome were analyzed.Results:Among 30,260 preg-nant women,185 fetuses were diagnosed with ARSA by prenatal ultrasound screening,with an incidence of 0.6％;5 fetuses(2.6％)were diagnosed by ultrasound in the first trimester,and the remaining were diagnosed by fetal grade Ⅲ structural ultrasound examination at 20～24 weeks' gestation.Among them,158 fetuses(85.4％)had isolated ARSA,and 27(14.6％)had complicated ARSA.Among fetuses with ARSA and other structural abnormal-ities,cardiovascular system accounted for the highest proportion(44.4％),followed by nervous system(22.2％)and urinary system(22.2％).Through genetic analysis,8.3％(4/48)fetuses with isolated ARSA and 40.0％(4/10)fetuses with complicated ARSA were found to have chromosomal numerical or structural abnormalities,with statis-tically significant difference between the two groups(P=0.024).Genetic analysis was completed in 48 isolated ARSA,and the positive rate of pathogenic copy number variants(CNV)was 4.2％(2/48),which was not signifi-cantly different from the pathogenic CNV incidence rate of 0.4％(1/239)in elderly pregnant cases during the same period(P=0.074).The Down syndrome positive likelihood ratio(LR+)for isolated ARSA was 2.5 and the Down syndrome LR+for complicated ARSA was 49.6.Conclusions:Complicated ARSA is often associated with cardiovascular abnormalities and is more likely to develop Down syndrome than isolated ARSA.Although the inci-dence of pCNV in isolated ARSA is slightly higher than the natural incidence,the correlation between pCNV and i-solated ARSA has not been clearly determined by the current sample size.

OBJECTIVE To investigate the effects of L-mimosine on the proliferation and apoptosis of melanoma cells and its molecular mechanisms.METHODS The effects of different concentrations of L-mimosine on the viability of melanoma A375 and B16 cells were examined by the MTT assay.The ability of L-Mimosine to affect colony formation was assessed by the plate colony for-mation assay.The effects of L-mimosine on cell apoptosis,reactive oxygen species(ROS),and mitochondrial membrane potential were analyzed by flow cytometry.The changes in the expression levels of intracellular proteins such as Bcl-2,Bax,Cyt C,Cleaved Caspase-3,Cleaved Caspase-9,Bim-EL,Bad,p-JNK,p-c-Jun,p-MKK4,and p-ASK1 were detected by Western blot.The tumor-bearing mouse model was subjected to histological and TUNEL staining analysis of tumor tissues after treatment with normal saline,L-mimosine alone,and L-mimosine in combination with N-acetylcysteine(NAC).RESULTS L-mimosine significantly inhibited the prolifera-tion of A375 and B16 cells and significantly promoted cell apoptosis.Western blot analysis showed that L-mimosine could significantly increase the content of Apaf-1 and Cyt C in the cytoplasm,up-regulate the expression of Cleaved PARP,Cleaved Caspase-3,Cleaved Caspase-9,Bax,Bim-EL and Bad,and down-regulate the expression of anti-apoptotic protein Bcl-2.Further experiments showed that L-mimosine significantly induced the accumulation of ROS in A375 cells and activated the JNK/c-Jun signaling pathway,which was manifested by the significant increase of p-JNK,p-c-Jun,p-MKK4 and p-ASK1.Additionally,the antioxidant NAC could significantly antagonize the ROS accumulation induced by L-mimosine,thereby reversing the pro-apoptotic effects of L-mi-mosine on melanoma cells.In vivo experiments,NAC also significantly antagonized the tumor growth inhibition induced by L-mi-mosine,as evidenced by increased tumor volume and reversed expression levels of apoptosis-related proteins.CONCLUSION L-mi-mosine induces apoptosis in melanoma cells by increasing ROS levels and activating the JNK/c-Jun signaling pathway.