Aim To study the regulatory effect of acupuncture pretreatment on ferroptosis of nerve cells in rats with ischemic stroke.Methods Sixty SD rats were randomly divided into sham middle cerebral artery occlusion(MCAO)group,MCAO group,and acupuncture+MCAO group.In the acupuncture+MCAO group,the acupuncture points of DU26,PC6,and SP6,were selected for acupuncture pretreatment,once a day for a total of 5 days.After pre-treatment,MCAO or sham MCAO models were prepared.The Zausinger sextintegral method was used to score the neuro-logical function of rats,and the infarct volume of brain tissue was calculated by TTC staining.Electron microscopy was used to observe the pathomorphological changes of brain tissue.The iron content was detected by colorimetric method,the content of malondialdehyde(MDA)and glutathione(GSH)was determined by ELISA,and the expression of glutathione peroxidase 4(GPX4)was detected by immunofluorescence.Results Compared with the sham MCAO group,the MCAO group had a decrease in neurological function scores,a significant increase in infarct volume,a decrease in the number of mitochondria under electron microscopy,a rupture and vacuolization of the inner mitochondrial cristae,an in-crease in the contents of iron and MDA in brain tissue,and a decrease in GSH content and GPX4 expression.Compared with the MCAO group,the acupuncture+MCAO group had an increase in neurological function scores,a decrease in infarct volume,a large number of mitochondria under electron microscopy,a clear structure,a decrease or disordered arrangement of some mitochondrial crest structures,a decrease in the contents of iron and MDA in brain tissue,and an increase in GSH content and GPX4 expression.Conclusion Acupuncture pretreatment can alleviate neurological damage in rats,and its mechanism may be related to regulating iron,GSH and MDA contents in brain tissue,and GPX4 expression,improving cell antioxidant capacity and inhibiting nerve cell ferroptosis.

Aim To study the regulatory effect of acupuncture pretreatment on ferroptosis of nerve cells in rats with ischemic stroke.Methods Sixty SD rats were randomly divided into sham middle cerebral artery occlusion(MCAO)group,MCAO group,and acupuncture+MCAO group.In the acupuncture+MCAO group,the acupuncture points of DU26,PC6,and SP6,were selected for acupuncture pretreatment,once a day for a total of 5 days.After pre-treatment,MCAO or sham MCAO models were prepared.The Zausinger sextintegral method was used to score the neuro-logical function of rats,and the infarct volume of brain tissue was calculated by TTC staining.Electron microscopy was used to observe the pathomorphological changes of brain tissue.The iron content was detected by colorimetric method,the content of malondialdehyde(MDA)and glutathione(GSH)was determined by ELISA,and the expression of glutathione peroxidase 4(GPX4)was detected by immunofluorescence.Results Compared with the sham MCAO group,the MCAO group had a decrease in neurological function scores,a significant increase in infarct volume,a decrease in the number of mitochondria under electron microscopy,a rupture and vacuolization of the inner mitochondrial cristae,an in-crease in the contents of iron and MDA in brain tissue,and a decrease in GSH content and GPX4 expression.Compared with the MCAO group,the acupuncture+MCAO group had an increase in neurological function scores,a decrease in infarct volume,a large number of mitochondria under electron microscopy,a clear structure,a decrease or disordered arrangement of some mitochondrial crest structures,a decrease in the contents of iron and MDA in brain tissue,and an increase in GSH content and GPX4 expression.Conclusion Acupuncture pretreatment can alleviate neurological damage in rats,and its mechanism may be related to regulating iron,GSH and MDA contents in brain tissue,and GPX4 expression,improving cell antioxidant capacity and inhibiting nerve cell ferroptosis.

Wumei Pills is mostly used to treat ulcerative colitis, irritable bowel syndrome, intestinal polyps, chronic atrophic gastritis, gastroesophageal reflux disease, gastric cancer and other digestive system diseases with its modified formula or combination with Western medicine. Wumei Pills can play a role in treating digestive system diseases through antioxidant stress, Inhibiting inflammatory response, regulating intestinal flora, anti-tumor, promoting intestinal mucosal repair, etc. Most of the related research on the mechanism of Wumei Pills in the treatment of digestive system diseases were studied in a single pathway. The relationship between other mechanisms and pathways is worthy of further exploration. In addition, the current research mostly focuses on the lower digestive system diseases with diarrhea as the main manifestation, and there is still room for research and reporting in the treatment of upper digestive system diseases.

Objective To explore the predictive value of cystatin C(Cys C),high mobility group box 1(HMGB1),and growth differentiation factor-15(GDF-15)levels for early infection after flap reconstruction for diabetic foot ulcer(DFU).Methods From July 2021 to March 2024,155 DFU patients treated in our hospital were included in DFU group.DFU patients were assigned into non-infection group(104 cases)and infection group(51 cases)according to whether there was infection at the operation site within one week after flap reconstruction.Control group included 85 patients with diabetes but without foot ulcer.Latex immunoturbidimetry was applied to detect serum Cys C level;enzyme linked immunosorbent assay to detect serum levels of HMGB1 and GDF-15;multivariate logistic regression to analyze the factors affecting early infection after flap reconstructionfor DFU,and receiver operating characteristic(ROC)curve to analyze the predictive value of serum Cys C,HMGB1,and GDF-15 levels for early infection after flap reconstruction for DFU.Results The expression levels of serum Cys C,HMGB1,and GDF-15 were obviously higher in the DFU group(P＜0.05)when compared with those in the control group.The expression levels of FPG,CRP,Cys C,HMGB1,and GDF-15 were obviously higher in the infection group(P＜0.05)when compared with those in the non-infection group.Cys C,HMGB1,GDF-15,FPG,and CRP were all inde-pendent risk factors for early infection after flap reconstruction for DFU(P＜0.05).The AUC predicted by serum Cys C,HMGB1,and GDF-15 alone for early infection after flap reconstruction for DFU was 0.810,0.850,and 0.828,respectively.The AUC predicted by the combination of these three markers was 0.930,which was better than that predicted by the three markers alone(ZCysC-three combination=3.381,ZHMGB1-three combination=2.588,ZGDF-15-three combination=2.857,all P＜0.05).Conclusions Cys C,HMGB1,and GDF-15 are upregulated in the serum of DFU patients,and all the three are factors affecting early infection after flap reconstruction for DFU.The combination of the three has high predictive value for early infection after DFU flap repair.

Objective To explore the predictive value of cystatin C(Cys C),high mobility group box 1(HMGB1),and growth differentiation factor-15(GDF-15)levels for early infection after flap reconstruction for diabetic foot ulcer(DFU).Methods From July 2021 to March 2024,155 DFU patients treated in our hospital were included in DFU group.DFU patients were assigned into non-infection group(104 cases)and infection group(51 cases)according to whether there was infection at the operation site within one week after flap reconstruction.Control group included 85 patients with diabetes but without foot ulcer.Latex immunoturbidimetry was applied to detect serum Cys C level;enzyme linked immunosorbent assay to detect serum levels of HMGB1 and GDF-15;multivariate logistic regression to analyze the factors affecting early infection after flap reconstructionfor DFU,and receiver operating characteristic(ROC)curve to analyze the predictive value of serum Cys C,HMGB1,and GDF-15 levels for early infection after flap reconstruction for DFU.Results The expression levels of serum Cys C,HMGB1,and GDF-15 were obviously higher in the DFU group(P＜0.05)when compared with those in the control group.The expression levels of FPG,CRP,Cys C,HMGB1,and GDF-15 were obviously higher in the infection group(P＜0.05)when compared with those in the non-infection group.Cys C,HMGB1,GDF-15,FPG,and CRP were all inde-pendent risk factors for early infection after flap reconstruction for DFU(P＜0.05).The AUC predicted by serum Cys C,HMGB1,and GDF-15 alone for early infection after flap reconstruction for DFU was 0.810,0.850,and 0.828,respectively.The AUC predicted by the combination of these three markers was 0.930,which was better than that predicted by the three markers alone(ZCysC-three combination=3.381,ZHMGB1-three combination=2.588,ZGDF-15-three combination=2.857,all P＜0.05).Conclusions Cys C,HMGB1,and GDF-15 are upregulated in the serum of DFU patients,and all the three are factors affecting early infection after flap reconstruction for DFU.The combination of the three has high predictive value for early infection after DFU flap repair.

Objective:To compare the safety and efficacy of the " step-up approach" versus the " step-jump approach" in treatment of infected pancreatic necrosis (IPN).Method:The clinical data of IPN patients who underwent step-up strategy or step-jump strategy treatment at the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from December 2018 to November 2022 were analyzed retrospectively. Propensity score matching (PSM) was done based on the nearest neighbor matching method (1: 1 ratio). After matching the baseline data (the caliper value was 0.01), a total of 62 patients with IPN were included, including 41 males and 21 females, aged (41.1±13.1) years old. Patients who were treated with the step-up strategy were included in the step-up group, while patients who were treated with the step-jump strategy were included in the step-jump group. There were 31 patients in each group after PSM, and the treatment effect of the two groups were compared.Results:Of the 62 patients with IPN, 43 received surgical intervention, and 19 were managed successfully using symptomatic anti-inflammatory treatment or percutaneous catheter drainage. The total hospitalization cost of patients in the step-jump group was significantly higher than that in the step-up group [122 000 (73 000, 179 000) yuan vs. 88 000 (46 000, 144 000) yuan, P=0.034]. The overall cure rate of IPN patients in the step-jump group was 93.5%(29/31). The 2 patients who died had type Ⅲ IPN. In the IPN patients in the step-up group were all cured, and the overall cure rate was 100%(31/31), with no death. There were no statistical differences between the two groups in the rates of death, postoperative complications, residual infection, debridement ≥2 times, and positive bacterial culture in blood or drainage fluid (all P>0.05). A total of 19.4% (12/62) patients had postoperative complications, including 4 patients with abdominal bleeding, 3 patients with new organ dysfunction, 2 patients with gastrointestinal bleeding, 2 patients with gastrointestinal fistula, and 1 patient with venous thrombosis in both lower limbs. Conclusion:Both the step-up treatment strategy and the step-jump treatment strategy were safe and effective for treatment of IPN patients.

Chronic fatigue syndrome （CFS） is a heterogeneous disease with dysfunction in multiple systems and multiple organs. Its etiology and pathogenesis have not been fully clarified， and its treatment also lacks specificity. The key to studying CFS is developing animal models that reflect the underlying mechanisms and etiology of CFS. The existing CFS modeling methods are complicated and not unified. By sorting out relevant literature，the present study evaluated the modeling methods，modeling standards，mechanisms， and clinical coincidence of the immune model，the stress model， and the disease-syndrome combination model in traditional Chinese medicine （TCM）. The immune model is mainly constructed from the perspective of pathophysiology， with easy operation and wide investigation， which can simulate the pathological characteristics of CFS to ensure pathogenesis research，but the experimental repeatability is general. Stress modeling is a common method for a variety of neuropsychiatric diseases，including CFS. Many different stressors can be employed to investigate the etiology of CFS， but their effects are unpredictable. Compared with the two western medicine models mentioned above，the TCM disease-syndrome combination model integrates modern medicine with TCM theory，with high clinical coincidence and great practical value. However，the TCM disease-syndrome combination model of CFS is still in the exploratory stage with a few types of models，which needs to be further improved， aiming to establish scientific，reasonable，simple， and efficient animal models to provide support for exploring the etiology，pathogenesis， and new treatment ideas of CFS.

Objective:To explore the core syndrome type and Chinese herbal medicine combination in Ulcerative Colitis (UC) remission phase based on the real and effective clinical data of the outpatient information system of the hospital.Methods:Medical records of patients with UC in remission who received Traditional Chinese Medicine (TCM) oral intervention from August 1, 2018 to October 31, 2021 in Jiangsu Provincial Hospital of Traditional Chinese Medicine were collected. Medcase V3.2 data record mining system was used, and the enhanced FPGrowth algorithm was used to build a strengthened association rule data mining model. Xminer Operation Tool was used for mining and logical analysis, and Medcase Chart was used for deconstruction analysis and graphical representation of quantitative trend data. Based on the statistical analysis results, the core syndrome types, pathogenesis evolution rules, and core TCM compatibility law in remission stage of UC were explored.Results:A total of 302 patients were collected. Diarrhea, bloody stool, mucus stool, fatigue, light tongue, fine pulse, paroxysmal abdominal pain, and colonoscopy found intestinal polyps were the core symptoms in UC remission phase. Spleen Qi Deficiency Syndrome, Spleen Deficiency and Dampness Syndrome, Spleen Deficiency and Toxin Accumulation Syndrome were the core syndrome type. In Spleen Qi Deficiency Syndrome, the core drug combinationed Codonopsis Radix, Atractylodis Macrocephalae Rhizoma, Poria, Glycyrrhizae Radix et Rhizoma, Aucklandiae Radix, Amomi Fructus, Angelicae Sinensis Radix, and Paeoniae Radix Alba. In Spleen Deficiency and Dampness Syndrome, the core drug combinationed Codonopsis Radix, Atractylodis Macrocephalae Rhizoma, Poria, Glycyrrhizae Radix et Rhizoma, Aucklandiae Radix, Coptidis Rhizoma, Amomi Fructus, and Saposhnikoviae Radix. In Spleen Deficiency and Toxin Accumulation Syndrome, the core drug combinationed Codonopsis Radix, Astragali Radix, Atractylodis Macrocephalae Rhizoma, Citri Reticulatae Pericarpium, Mume Fructus, Sophorae Flos, Coptidis Rhizoma, and Saposhnikoviae Radix.Conclusion:Spleen deficiency was the core syndrome type in UC remission phase. The Chinese herbal medicine treatment options included replenishing qi supplemented with harmonizing the stomach, promoting blood circulation, stopping bleeding, removing dampness, clearing heat, and relieving depression.

ObjectiveTo determine whether HBV DNA polymerase is associated with T-cell failure and thus mediates the immune escape of HBV-related hepatocellular carcinoma （HCC） tumor cells， and to investigate the specific molecular mechanisms. MethodsLiver cancer cell lines Huh7 and HepG2 stably transfected with HBV DNA polymerase expression plasmid with Flag （Flag-HBV-P） and intercellular adhesion molecule-1 （ICAM1） were co-cultured with Jurkat cells， and MTT assay， qRT-PCR， and ELISA were used to measure Jurkat cell proliferation， activation （CD69 expression）， and secretion of the cytokine IFN-γ. RNA-seq was used to screen for differentially expressed immune-associated molecules between stably transfected cell lines and control cells， and mRNA half-life and protein half-life assays were used to determine the specific levels of the immune-associated molecules that were affected by HBV DNA polymerase. Related websites were used to predict the transcription factors that may bind to the promoter region of this immune-associated molecule， Western blot was used to verify the effect of transcription factors on the immune-associated molecule， and rescue experiment was used to determine whether HBV DNA polymerase affects the expression level of the immune-associated molecule through this transcription factor. The independent-samples t test was used for comparison between two groups. ResultsThe experimental group had significant reductions in Jurkat cell proliferation， activation， and cytokine secretion compared with the control group （all P<0.01）. Compared with the control group， the experimental group （Huh7 and HepG2 cell lines） had significant reductions in the mRNA and protein expression levels of ICAM1 （all P<0.01）. Website prediction identified the ICAM1 promoter and preliminarily highlighted NFKB1， RELA， and STAT3. Compared with the control group， the experimental group （Huh7 and HepG2 cell lines） had a significant reduction in the protein expression level of p65 （all P<0.01）. After p65 overexpression， there was a significant increase in the protein expression level of ICAM1， and after the expression of p65 was reduced， there was a significant reduction in the protein expression level of ICAM1 （all P<0.01）. In the rescue experiment， there was no significant difference in the protein expression level of ICAM1 between the control group and the experimental group after p65 overexpression （all P>0.05）. After the overexpression of ICAM1， there were no significant differences in the proliferation， activation， and cytokine secretion of Jurkat cells between the control group and the experimental group （Huh7 and HepG2 cell lines） （all P>0.05）. ConclusionHBV DNA polymerase downregulates the level of ICAM1 to mediate HCC immune escape by inhibiting the expression of p65 in NF-κB.

Objective:To report embryonic testicular regression syndrome(ETRS) caused by DHX37 heterozygous variant for the first time in China and summarize the clinical manifestations of ETRS as to improve the understanding of doctors for this disease.Methods:The clinical data and whole exome sequencing results of five cases of ETRS from Shenzhen Children′s Hospital were collected. The reported cases of DHX37 heterozygous variant were reviewed.Results:Five patients with ETRS visited the doctors at the age of 2 months to 5 years and 5 months. Three patients raised as males came to hospital due to virilition and 2 female patients visited a doctor due to clitoral hypertrophy. No uterus was detected by ultrasound in all patients. The gonadal pathologies from 4 cases displayed no testicular tissue or gonadal dysgenesis, complicated with gonadoblastoma in one case. The genetic testing revealed that the heterozygous variant(c.923G>A, p. R308Q) in DHX37 was found in 2 cases, without variant in other 3 cases. According to the review, ETRS and 46, XY gonadal dysgenesis due to DHX37 herozygous variant was firstly reported in 2019. A total of 40 cases, including 21 cases of ETRS, presented with the virilition or female phenotype, with the disappearance of testicular tissue as the main pathologies. There is no report in China.Conclusion:The article summarized the clinical manifestations and whole exome sequencing results of 5 patients with ETRS, among which two cases were caused by DHX37 variants and one was complicated with gonadoblastoma.