1.Comparison of clinical and cranial magnetic resonance imaging features between patients with different ATP7B mutations of neurological hepatolenticular degeneration
Yongguang SHI ; Gongqiang WANG
Journal of Apoplexy and Nervous Diseases 2026;43(2):114-118
Objective To compare the clinical and cranial magnetic resonance imaging (MRI) features of neurological hepatolenticular degeneration (also known as Wilson disease,WD) with two different ATP7B gene mutations, and to investigate the association between the clinical and cranial MRI features in patients with the two mutation types of neurological WD. Methods The neurological WD patients with p.Arg778Leu or p.Pro992Leu homozygous mutation who were hospitalized in Affiliated Hospital of Neurology Institute, Anhui University of Chinese Medicine, from May 2014 to May 2025 were enrolled, and a retrospective analysis was performed for their demographic data, clinical manifestations, serological markers, and cranial MRI data to compare the differences between the two mutation types of neurological WD. Results A total of 103 neurological WD patients were enrolled, among whom there were 65 patients with p.Arg778Leu-mutant WD and 38 patients with p.Pro992Leu-mutant WD. There were no significant differences in demographics, clinical manifestations, and most serological markers between the two mutation types of WD, while there was a significant difference in cranial MRI findings between two groups, with significant differences in the damage of the thalamus (χ2=17.834,P<0.001),the midbrain (χ2=12.579, P<0.001), and the pons (χ2=10.605, P=0.001) between the patients with p.Arg778Leu-mutant WD and those with p.Pro992Leu-mutant WD, and the multivariate analysis also showed significant differences in the above indicators (P<0.05). Conclusion Demographic data, clinical manifestations, and serological markers are not associated with gene mutation types in neurological WD, while cranial MRI manifestations are associated with gene mutation types, among which p.Arg778Leu mutation of the ATP7B gene is more likely to involve the thalamus, the midbrain, and the pons.
Genotype
2.Research progress on adolescents emotional responses to social media and their health effects
CHEN Qian, WANG Shanshan, WAN Yuhui
Chinese Journal of School Health 2026;47(5):737-740
Abstract
To further differentiate the differentiated effects of emotional responses to social media among adolescents, the study systematically reviews the main current methods for measuring social media emotional responses. It elaborates on the impacts of adolescents emotional responses to social media on their physical health, mental health, and social adaptation, as well as the multiple pathways and potential mechanisms through which adverse health effects are induced. It also highlights the current lack of empirical support for biological mechanisms in existing research, and provides a reference for future in depth exploration of biological mechanisms and the development of effective intervention strategies.
3.Research progress on effects of environmental endocrine disruptors on pubertal timing in children and adolescents
WANG Jie, LUO Ling, TAO Fangbiao, YAN Shuangqin
Chinese Journal of School Health 2026;47(5):751-755
Abstract
In order to explore the influence of different environmental endocrine disruptors (EEDs) on the onset of youth in children and adolescents, the study introduces the advance trend of the onset of youth in children and adolescents at home and abroad, and the influence of EEDs, such as bisphenol A, organophosphate esters, phthalic acid esters, per and polyfluoroalkyl substances, which children and adolescents often contact on the onset of youth. The related mechanisms are expounded from the aspects of direct interference of EEDs on neuroendocrine axis, hormone simulation and antagonism mediated by receptors, epigenetic programming changes, indirect pathways mediated by obesity and inflammation, etc., in order to provide scientific basis for formulating preventive measures for abnormal puberty onset of children and adolescents in EEDs exposure and promote their health.
4.血浆神经胶质细胞原纤维酸性蛋白及同型半胱氨酸水平对肝豆状核变性的诊断及分型鉴别诊断价值
Journal of Apoplexy and Nervous Diseases 2026;43(2):119-124
摘要
目的 探讨血浆神经胶质细胞原纤维酸性蛋白(GFAP)及同型半胱氨酸(Hcy)水平对肝豆状核变性(又称肝豆状核变性,WD)的诊断及肝脑型鉴别诊断价值。方法 招募安徽中医药大学第一附属医院脑病中心2023年1月—2025年1月收治的WD患者共120例,其中WD脑型63例,WD肝型57例,以及同期在体检中心筛查的30名健康志愿者。采用ELISA法测定纳入对象血浆GFAP、Hcy水平,进行组间差异性比较和ROC曲线分析。并运用Spearman相关分析探讨血浆GFAP、Hcy水平与统一肝豆状核变性评定量表评分(UWDRS)、24 h尿铜及血清铜蓝蛋白(CER)水平的相关性。结果 WD肝型及脑型患者的血浆GFAP水平均显著高于对照组(P<0.05),且WD脑型较WD肝型升高更为显著(P<0.05)。血浆Hcy水平也在WD肝型及脑型患者中明显升高(P<0.05),但在WD肝型、脑型间未表现出显著差异。血浆GFAP诊断WD脑型的曲线下面积(AUC)为0.861,截断值为135.71 pg/ml,敏感度68.3%,特异度82.3%;该指标诊断WD肝型的AUC为0.695,截断值为129.84 pg/ml,敏感度64.7%,特异度83.3%;其在WD肝型及脑型鉴别诊断中的AUC为0.75,截断值为151.12 pg/ml,敏感度73.9%,特异度87.8%。血浆Hcy诊断WD的AUC为0.788,截断值为15.59 μmol/L,敏感性77.9%,特异性66.7%。Spearman相关性分析结果显示,WD肝型及脑型患者血浆GFAP、Hcy水平与UWDRS评分及24 h尿铜水平均呈正相关(P<0.05),与CER水平无显著相关性(P>0.05)。结论 血浆GFAP、Hcy水平与WD神经及肝脏功能受损程度密切相关,且为早期诊断WD以及血浆GFAP对WD各分型的鉴别诊断提供了一定的临床价值。
Abstract
Objective To investigate the value of plasma glial fibrillary acidic protein (GFAP) and homocysteine (Hcy) in the diagnosis of hepatolenticular degeneration (also know as Wilson disease, WD) and the differential diagnosis of the hepatic and neurological forms of WD. Methods A total of 120 WD patients who were admitted to Encephalopathy Center of our hospital from January 2023 to January 2025 were enrolled, among whom there were 63 patients with neurological WD and 57 patients with hepatic WD, and 30 healthy volunteers who underwent physical examination during the same period of time were enrolled as control group. ELISA was used to measure the plasma levels of GFAP and Hcy, and the differences between groups were analyzed. The receiver operating characteristic(ROC) curve analysis was performed, and the Spearman correlation analysis was used to investigate the correlation of the plasma levels of GFAP and Hcy with Unified Wilson Disease Rating Scale (UWDRS) score, 24-hour urinary copper, and the serum level of ceruloplasmin (CER). Results The patients with hepatic or neurological WD had a significantly higher plasma level of GFAP than the control group(P<0.05), and the patients with neurological WD had a significantly greater increase than those with hepatic WD(P<0.05). The patients with hepatic or neurological WD also had a significant increase in the plasma level of Hcy(P<0.05), but with no significant difference between the patients with hepatic WD and those with neurological WD.Plasma GFAP had an area under the ROC curve(AUC) of 0.861 in the diagnosis of neurological WD, with a cut-off value of 135.71 pg/ml, a sensitivity of 68.3%,and a specificity of 82.3%;plasma GFAP had an AUC of 0.695 in the diagnosis of hepatic WD, with a cut-off value of 129.84 pg/ml, a sensitivity of 64.7%, and a specificity of 83.3%; in the differential diagnosis of hepatic and neurological WD, plasma GFAP had an AUC of 0.75, with a cut-off value of 151.12 pg/ml,a sensitivity of 73.9%, and a specificity of 87.8%. Plasma Hcy had an AUC of 0.788 in the diagnosis of WD, with a cut-off value of 15.59 μmol/L, sensitivity of 77.9%, and specificity of 66.7%. The Spearman correlation analysis showed that in the patients with hepatic or neurological WD, the plasma levels of GFAP and Hcy were positively correlated with UWDRS score and 24-hour urinary copper (P<0.05), but they were not significantly correlated with the level of CER (P>0.05). Conclusion The plasma levels of GFAP and Hcy are closely associated with the degree of neurological and hepatic impairment in WD, which provides a certain clinical value for the early diagnosis of WD and the differential diagnosis of hepatic and neurological WD.
Homocysteine
5.Clinical Research and Basic Study on Effect of Huangqin Qingre Chubi Capsule (黄芩清热除痹胶囊) on Self-Perception of Patients and Immune Inflammation in Rheumatoid Arthritis
Fanfan WANG ; Jian LIU ; Qin ZHOU ; Jianting WEN ; Yue SUN ; Mingyu HE
Journal of Traditional Chinese Medicine 2026;67(5):544-556
ObjectiveTo evaluate the comprehensive intervention effects of Huangqin Qingre Chubi Capsule (黄芩清热除痹胶囊, HQC) on self-perception of patients (SPP) and immune inflammation in patients with rheumatoid arthritis (RA), and to explore its potential mechanisms. MethodsClinical data of 452 RA patients were retrospectively collected. Patients were divided into a control group (274 cases), treated with conventional western medicine, and an observation group (178 cases), treated with HQC for at least 2 weeks in addition to conventional western medicine. The treatment duration was 2 weeks for both groups. Propensity score matching (PSM) was performed at a ratio of 1∶1 to match patients between groups. SPP including the Chinese version of the short form-36 health survey (SF-36), self-rating anxiety scale (SAS), self-rating depression scale (SDS), visual analog scale (VAS), and Chinese patient-reported index for rheumatoid arthritis (CPRI-RA), as well as immune inflammatory indicators, including erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP), interleukin-6 (IL-6), immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), complement C3, and complement C4, were collected before and after treatment. Spearman correlation analysis was used to assess the relationships between SPP and immune inflammatory indicators. Logistic regression, association rule analysis, and mediation analysis were performed to evaluate the effects and potential pathways of HQC on SPP and immune inflammatory indicators. Network pharmacology was applied to identify the active components and core targets of HQC in the treatment of RA, followed by molecular docking verification. In cell experiments, cells were divided into normal group, model group, 20% medicated serum group, and 80 nmol/L control group. Human synovial fibroblasts (FLS) were cultured with complete medium in the normal group, while human rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) were cultured in the model group. In the 20% medicated serum group, RA-FLS were cultured with medium containing 20% HQC-medicated serum, and in the 80 nmol/L control group, RA-FLS were cultured with complete medium containing 80 nmol/L methotrexate suspension. After 48 h of culture, cell viability was detected by cell counting kit-8 (CCK-8) assay. Levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10) in the cell supernatant were measured by enzyme-linked immunosorbent assay (ELISA). Protein levels of matrix metalloproteinase 9 (MMP9), transcription factor AP-1 subunit (JUN), vascular endothelial growth factor A (VEGFA), and C-X-C motif chemokine ligand 8 (CXCL8) were detected by Western Blot, and cell migration ability was evaluated using Transwell assay. ResultsAfter PSM, 178 cases were included in each group. After treatment, SF-36 scores increased, while scores of SAS, SDS, VAS and CPRI-RA, levels of ESR, hs-CRP, IL-6, complement C3, and complement C4 levels decreased in both groups; IgG and IgM levels were also reduced in the observation group (P<0.05). Physical functioning (correlation coefficient -0.19, P<0.05) and social functioning (correlation coefficient -0.18, P<0.05) of SF-36 were negatively correlated with hs-CRP, while VAS score was positively correlated with hs-CRP (correlation coefficient 0.19, P<0.05). HQC showed high associations with improvements in multiple indicators of SPP and immune inflammatory, and acted as a protective factor for the improvement of several SPP; hs-CRP and ESR played partial mediating roles in the improvement of SPP induced by HQC (P<0.05). Network pharmacology analysis identified baicalein, quercetin, α1-sitosterol, β-sitosterol, stigmasterol, baicalin, and crocetin as the core active components, and JUN, IL-6, VEGFA, MMP9, IL-1β, and CXCL8 as the core targets. Molecular docking results showed strong binding affinities of quercetin with VEGFA, JUN, MMP9, IL-6, and IL-1β, of baicalin with VEGFA and MMP9, and of wogonin with CXCL8. Cell experiments demonstrated that HQC and methotrexate inhibited RA-FLS viability and migration, reduced levels of IL-1β, IL-6, and IL-8, decreased protein levels of MMP9, JUN, VEGFA, and CXCL8, and increased IL-10 levels (P<0.05). ConclusionHQC can improve SPP in RA by regulating immune inflammatory responses. Its mechanism may be related to multi-pathway and multi-target inhibition of synovial cell inflammation and migration.
6.Rapid identification of Plantago asiatica L. in different populations
Qian XU ; Kexin WU ; Jiaru WANG ; Yunfei HU ; Ruonan XIE ; Wenwen HONG
Journal of Pharmaceutical Practice and Service 2026;44(5):239-246
Objective To study the mini-character and microscopic features of Plantago asiatica from different populations and summarize the exclusive features to provide a reference for the effective identification of Plantago asiatica. Methods Stereomicroscope and optical microscope were used to identify 30 batches of Plantago asiatica from different populations.The similarities and differences in mini-character and microscopic features of Plantago asiatica among different populations were identified. Results The differences in mini character between the Plantago asiatica from different populations were mainly reflected in whether there was fluff on the surface of leaves, inflorescence peduncles, and persistent sepals, as well as whether the epidermis of fibrous roots was flaky. The differences in microscopic characteristics between the Plantago asiatica from different populations were mainly reflected in the number of non-glandular hairs on the leaf surface, the shape of the petiole endothelial layer cells, and the number of large vascular bundles, and the number of layers of mesophyll palisade tissue cells, etc. Conclusion Plantago asiatica from different populations can be identified through mini-character and microscopic; by comparing the relevant identification features, which can provide a basis for revising and improving the standards of Plantago asiatica.
7.The Diversity of Filamentous Morphologies and Magnetic Sensitivity Modulated by Diverse MagR Expression in Bacteria
Ya-Fei CHANG ; Jing ZHANG ; Peng ZHANG ; Xiu-Juan ZHOU ; Meng-Ke WEI ; Tian-Tian CAI ; Pei-Qi HE ; Jun-Feng WANG ; Can XIE
Progress in Biochemistry and Biophysics 2026;53(5):1439-1456
Objective Magnetoreception, the remarkable ability of diverse animals to sense and utilize the geomagnetic field for orientation and navigation, remains a molecularly unresolved mystery in sensory biology. The putative magnetoreceptor (MagR, previously known as IscA1) is a highly conserved iron-sulfur protein implicated in both magnetoreception and iron metabolism; however, the functional diversity among its cross-species homologs remains poorly understood. Cellular morphology is a key genetically determined trait that can be altered through genetic or environmental modifications—a process known as cell morphology engineering. Constructing engineered cells with specific morphological features and magnetic sensitivity to achieve remote, non-invasive magnetic modulation represents a crucial goal in this field with significant application potential. Therefore, this study aims to systematically investigate the effects of MagR heterologous expression on bacterial morphology and magnetic sensing capabilities, screen for MagR-based magnetically sensitive morphology engineering pathways, and reveal the underlying molecular mechanisms. Methods We systematically screened 28 MagR homologous genes from diverse prokaryotic and animal taxa to evaluate their expression and corresponding phenotypic effects in Escherichia coli (E. coli). To compare the differential magnetic responses among bacteria expressing various recombinant MagR proteins, we utilized high-throughput automated bright-field microscopic imaging and scanning electron microscopy (SEM). Furthermore, comprehensive biochemical and biophysical characterizations of iron and iron-sulfur cluster binding were performed using Ferrozine colorimetric assays, electron paramagnetic resonance (EPR) spectroscopy, ultraviolet-visible (UV-Vis) absorption, and circular dichroism (CD) spectroscopy. Additionally, 100 mT static magnetic field (SMF) exposure experiments were conducted to assess magnetically tunable phenotypes, while the intrinsic magnetic properties of purified MagR proteins were directly measured using a superconducting quantum interference device (SQUID) magnetometer. Results Our results demonstrated that the heterologous expression of MagR homologs induced varying degrees of bacterial filamentation. From this comprehensive screen, two distinct morphological patterns were identified: hydra (Hydra vulgaris) MagR (hyMagR) promoted uniform cell elongation and filamentation, exhibiting robust magnetic sensitivity manifested as significantly enhanced filamentation under the 100 mT SMF. In contrast, pigeon (Columba livia) MagR (clMagR) induced only low-frequency, extreme filamentation (sporadically exceeding 80 μm) with a relatively weaker magnetic morphological response. Mechanistically, our data unambiguously proved that these phenotypic differences are primarily driven by distinct iron redox preferences rather than total cellular iron accumulation. Specifically, hyMagR preferentially binds ferrous iron (Fe2+), whereas clMagR favors ferric iron (Fe3+) and forms more stable iron-sulfur clusters. Intriguingly, although SQUID magnetometry showed that purified clMagR exhibited approximately five-fold higher mass magnetic susceptibility than hyMagR, its cellular magnetic response was weaker. We hypothesize that the Fe2+-preferred intracellular environment associated with hyMagR overexpression primes the cell for enhanced generation of reactive oxygen species (ROS) via the Fenton reaction. Exposure to an SMF synergizes with this primed redox state, triggering the bacterial SOS response and upregulating cell division inhibitors to efficiently induce uniform filamentation. Conclusion Our findings identify the Fe2+/Fe3+ redox state as a critical determinant of MagR-mediated morphological remodeling and magnetic responsiveness. This discovery suggests a potential strategy for engineering magnetically responsive cellular systems for synthetic biology applications, and provides a plausible framework, which potentially combines intrinsic protein magnetism with redox-state modulation, for further investigating the evolutionary mechanisms of MagR-mediated magnetoreception.
8.The Diversity of Filamentous Morphologies and Magnetic Sensitivity Modulated by Diverse MagR Expression in Bacteria
Ya-Fei CHANG ; Jing ZHANG ; Peng ZHANG ; Xiu-Juan ZHOU ; Meng-Ke WEI ; Tian-Tian CAI ; Pei-Qi HE ; Jun-Feng WANG ; Can XIE
Progress in Biochemistry and Biophysics 2026;53(5):1439-1456
Objective Magnetoreception, the remarkable ability of diverse animals to sense and utilize the geomagnetic field for orientation and navigation, remains a molecularly unresolved mystery in sensory biology. The putative magnetoreceptor (MagR, previously known as IscA1) is a highly conserved iron-sulfur protein implicated in both magnetoreception and iron metabolism; however, the functional diversity among its cross-species homologs remains poorly understood. Cellular morphology is a key genetically determined trait that can be altered through genetic or environmental modifications—a process known as cell morphology engineering. Constructing engineered cells with specific morphological features and magnetic sensitivity to achieve remote, non-invasive magnetic modulation represents a crucial goal in this field with significant application potential. Therefore, this study aims to systematically investigate the effects of MagR heterologous expression on bacterial morphology and magnetic sensing capabilities, screen for MagR-based magnetically sensitive morphology engineering pathways, and reveal the underlying molecular mechanisms. Methods We systematically screened 28 MagR homologous genes from diverse prokaryotic and animal taxa to evaluate their expression and corresponding phenotypic effects in Escherichia coli (E. coli). To compare the differential magnetic responses among bacteria expressing various recombinant MagR proteins, we utilized high-throughput automated bright-field microscopic imaging and scanning electron microscopy (SEM). Furthermore, comprehensive biochemical and biophysical characterizations of iron and iron-sulfur cluster binding were performed using Ferrozine colorimetric assays, electron paramagnetic resonance (EPR) spectroscopy, ultraviolet-visible (UV-Vis) absorption, and circular dichroism (CD) spectroscopy. Additionally, 100 mT static magnetic field (SMF) exposure experiments were conducted to assess magnetically tunable phenotypes, while the intrinsic magnetic properties of purified MagR proteins were directly measured using a superconducting quantum interference device (SQUID) magnetometer. Results Our results demonstrated that the heterologous expression of MagR homologs induced varying degrees of bacterial filamentation. From this comprehensive screen, two distinct morphological patterns were identified: hydra (Hydra vulgaris) MagR (hyMagR) promoted uniform cell elongation and filamentation, exhibiting robust magnetic sensitivity manifested as significantly enhanced filamentation under the 100 mT SMF. In contrast, pigeon (Columba livia) MagR (clMagR) induced only low-frequency, extreme filamentation (sporadically exceeding 80 μm) with a relatively weaker magnetic morphological response. Mechanistically, our data unambiguously proved that these phenotypic differences are primarily driven by distinct iron redox preferences rather than total cellular iron accumulation. Specifically, hyMagR preferentially binds ferrous iron (Fe2+), whereas clMagR favors ferric iron (Fe3+) and forms more stable iron-sulfur clusters. Intriguingly, although SQUID magnetometry showed that purified clMagR exhibited approximately five-fold higher mass magnetic susceptibility than hyMagR, its cellular magnetic response was weaker. We hypothesize that the Fe2+-preferred intracellular environment associated with hyMagR overexpression primes the cell for enhanced generation of reactive oxygen species (ROS) via the Fenton reaction. Exposure to an SMF synergizes with this primed redox state, triggering the bacterial SOS response and upregulating cell division inhibitors to efficiently induce uniform filamentation. Conclusion Our findings identify the Fe2+/Fe3+ redox state as a critical determinant of MagR-mediated morphological remodeling and magnetic responsiveness. This discovery suggests a potential strategy for engineering magnetically responsive cellular systems for synthetic biology applications, and provides a plausible framework, which potentially combines intrinsic protein magnetism with redox-state modulation, for further investigating the evolutionary mechanisms of MagR-mediated magnetoreception.
9.The effect of Chuju total flavonoids on the current and protein expression of BKCa channels in rat middle cerebral artery VSMC
Yuwen LI ; Xiao WANG ; Miao WU ; Shuo CHEN ; Zhiwu CHEN
Acta Universitatis Medicinalis Anhui 2026;61(3):387-394
ObjectiveTo investigate the relationship between the vasodilation and hydrogen sulfide (H2S) mechanism of total flavonoids of chrysanthemum (TFCC) and the large conductance Ca2+- activated K+ (BKCa) channels on vascular smooth muscle cells (VSMCs) of the middle cerebral artery in rats. In addition, this study will also investigate the effect of TFCC on the expression of BKCa channel alpha protein in rat middle cerebral artery VSMCs. MethodsThe primary method employed was acute digestion to isolate VSMCs from the middle cerebral artery of rats; whole-cell patch-clamp techniques were used to measure BKCa channel currents; primary tissue adherence culture was utilized to cultivate VSMCs from the middle cerebral artery of rats; Western blot were employed to determine protein expression levels. ResultsIn whole-cell patch-clamp experiments, both the H2S donor NaHS (100 μmol/L) and endogenous H2S enhanced BKCa channel currents. TFCC (30, 90, and 270 mg/L) also activatedBKCa channels and exhibited a certain concentration-dependent effect. Even after blocking endogenous H2S production, TFCC (270 mg/L) still activated BKCa channels in VSMCs of the middle cerebral artery in rats. In Western blot experiments, the α-subunit of BKCa channel proteins was expressed in all groups of cells, but TFCC (30, 90, and 270 mg/L) and inhibitor IBTX group did not affect the expression of channel protein content.Conclusion TFCC can promote the opening of BKCa channels by promoting the generation of endogenous H2S, or directly activate BKCa channels, thereby playing a role in relaxing cerebral blood vessels. However, TFCC had no significant effect on the expression of BKCa channel proteins.
10.Ershen Zhenwu Decoction Treats Chronic Heart Failure by Regulating miR-423-5p/Smad7/TGF-β1/Smads Axis and Myocardial Fibrosis Indicators
Lan GE ; Zhenpeng ZHU ; Xinyue WANG ; Dan CHENG ; Yulong LIU ; Maomao ZHANG ; Xiaoyu CHENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(3):157-165
ObjectiveTo investigate the clinical effect of Ershen Zhenwu Decoction on chronic heart failure (CHF) due to heart-kidney Yang deficiency and blood stasis and its regulatory effects on miR-423-5p/Smad7/transforming growth factor-β1 (TGF-β1)/Smads axis and myocardial fibrosis indicators. MethodsOne hundred and fourteen patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction (HFmrEF) were randomly allocated into a control group and an observation group. The control group was treated with dapagliflozin tablets, sacubitril-valsartan sodium tablets, metoprolol succinate, and spironolactone, and the observation group was treated with Ershen Zhenwu Decoction on the basis of the therapy in the control group. The course of treatment was 8 weeks in both groups. The 6-min walking distance, New York Heart Association (NYHA) heart function grade, Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, N-terminal pro-B-type natriuretic peptide (NT-proBNP), angiotensin Ⅱ (Ang Ⅱ), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), interventricular septum thickness at diastole (IVSd), left ventricular end-diastolic posterior wall thickness (LVPWd), left ventricular shortening fraction (FS), miR-423-5p, Smad7, Smad2, Smad3, Smad4, TGF-β1, Ang Ⅱ, type Ⅰ collagen (Col Ⅰ), type Ⅲ collagen (Col Ⅲ), mRNA levels of fibronectin (Fn) and α-smooth muscle actin (α-SMA) in the myocardial tissue were observed before and after treatment in both groups to evaluate the efficacy of cardiac function and drug safety. ResultsAfter treatment, both groups showed declined levels of NT-proBNP, Ang Ⅱ, miR-423-5p, Smad2, Smad3, Smad4, TGF-β1, Col Ⅰ, Col Ⅲ, and mRNA levels of Fn and α-SMA (P0.05), and the levels of the indicators above were lower in the observation group than in the control group (P0.05). After treatment, the Smad7 level increased obviously in both groups (P0.05) and was higher in the observation group than in the control group (P0.05). After treatment, both groups showed decreased MLHFQ scores and increased 6-min walking distance (P0.05), and the observation group had lower MLHFQ score and longer 6-min walking distance than the control group (P0.05). After treatment, the control group showed increased LVEF and FS (P0.05) and the observation group showcased decreased LVIDd and LVIDs and increased LVEF and FS (P0.05). Moreover, the observation group had lower LVIDd and LVIDs (P0.05) and higher LVEF and FS (P0.05) than the control group. The total response rate of cardiac function in the observation group was 90.38% (47/52), which was higher than that (70.59%, 36/51) in the control group (P0.05). No adverse reactions associated with Ershen Zhenwu Decoction were observed during the study period. ConclusionErshen Zhenwu Decoction can improve the cardiac function, exercise tolerance, and quality of life, regulate neuroendocrine factors, and slow down/reverse myocardial remodeling in the patients with HFrEF and HFmrEF (syndrome of heart-kidney Yang deficiency and blood stasis by regulating the miR-423-5p/Smad7/TGF-β1/Smads axis, inhibiting α-SMA and Fn expression, and alleviating myocardial fibrosis. It is worthy of further study.


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