Professor Wu Mianhua,a renowned national traditional Chinese medicine(TCM)practitioner,proposed the"deficient qi and Kenang"theory based on the doctrines of"deficient qi"and"Kenang".This theory is applied to the pathogenesis analysis and clinical syndrome differentiation and treatment of brain tumors.It posits that the fundamental pathogenesis of brain tumors involves orig-inal qi deficiency,internal generation of deficient qi,intermingling of phlegm and blood stasis,and conglomeration of toxins into nest-like foci.The treatment strategy emphasizes reinforcing healthy qi,regulating qi,resolving phlegm,dispelling stasis,attacking toxins,dispersing nodules,and adjusting treatment according to disease stages.In the early stage,it is to support healthy qi and regulate qi to remove qi deficiency;in the middle stage,it is to dissipate phlegm and expel blood stasis to resolve pathological nests;in the late stage,it is to attack toxins and resolve masses to break up nest sac.Throughout the treatment,strictly adhere to the principle of"rein-forcing healthy qi without retaining pathogens,and breaking accumulations without impairing healthy qi".

Objective:Chineselization of patient empowerment scale suitable for adult rehabilitation patients with long-term diseases-the Gothenburg empowerment scale(GES).To evaluate the reliability,validity and cultural applicability of the Chinese version GES in limb disabilities.Method:The Chinese version of the GES was produced by translating,back translating,and adjusting the GES according to the process of Beaton,DE.Convenience sampling method was used to select patients with limb disabilities over 18 years old from Shanghai YangZhi rehabilitation hospital as research object.The factor validi-ty,discriminant validity,convergent validity,confirmatory factor analysis(CFA)and exploratory structural equa-tion model(ESEM)were evaluated by Mplus 8.3.Adopt Cronbach's α coefficient and McDonald's ω coeffi-cient were used for reliability test of the scale.The floor and ceiling effects were used to evaluate the respon-siveness of the scale.Result:Total 274 valid samples with limb disabilities were obtained.The Chinese version GES consisted of 15 items,with 3 items connected to each dimension:Knowledge and understanding,personal control,identity,shared decision-making,and Enabling others.The Cronbach's α of total scale as well as the five dimensions ranged from 0.759-0.896.The McDonald's ω ranged from 0.737-0.953 in CFA and ESEM.CFA,ESEM,and second-order confirmatory factor analysis model all fitted well.The ESEM's fit indices(χ2/df=1.113,RMSEA=0.020,TLI=0.994,CFI=0.998,SRMR=0.014)were significantly better than the CFA's fit indices(χ2/df=1.516,RM-SEA=0.043,TLI=0.972,CFI=0.978,SRMR=0.042).The Chinese version GES had good discriminate and con-vergent validity,and responsiveness was good.Conclusion:The various indicators of the Chinese version GES meet the requirements of psychometrics and can be used in the mental study of adult limb disability rehabilitation patients.

Many female patients with inflammatory bowel disease (IBD) are of reproductive age, and addressing fertility-related issues is an important part of comprehensive treatment. Although the fertility of female IBD patients does not differ significantly from that of the general population, many women with IBD opt for childlessness. This voluntary childlessness may stem from concerns about the adverse effects of IBD and its treatment on fertility, pregnancy, and newborns. A lack of in depth understanding of fertility, socioeconomic status, demographic factors, and insufficient professional medical advice may also contribute to patients' decision to choose voluntary childlessness. This article analyzes the factors influencing voluntary childlessness in female IBD patients and summarizes recommendations aimed at reducing trend, to enhance fertility awareness among female IBD patients and providing useful references for developing reasonable fertility plans.

Professor Wu Mianhua,a renowned national traditional Chinese medicine(TCM)practitioner,proposed the"deficient qi and Kenang"theory based on the doctrines of"deficient qi"and"Kenang".This theory is applied to the pathogenesis analysis and clinical syndrome differentiation and treatment of brain tumors.It posits that the fundamental pathogenesis of brain tumors involves orig-inal qi deficiency,internal generation of deficient qi,intermingling of phlegm and blood stasis,and conglomeration of toxins into nest-like foci.The treatment strategy emphasizes reinforcing healthy qi,regulating qi,resolving phlegm,dispelling stasis,attacking toxins,dispersing nodules,and adjusting treatment according to disease stages.In the early stage,it is to support healthy qi and regulate qi to remove qi deficiency;in the middle stage,it is to dissipate phlegm and expel blood stasis to resolve pathological nests;in the late stage,it is to attack toxins and resolve masses to break up nest sac.Throughout the treatment,strictly adhere to the principle of"rein-forcing healthy qi without retaining pathogens,and breaking accumulations without impairing healthy qi".

Objective:Chineselization of patient empowerment scale suitable for adult rehabilitation patients with long-term diseases-the Gothenburg empowerment scale(GES).To evaluate the reliability,validity and cultural applicability of the Chinese version GES in limb disabilities.Method:The Chinese version of the GES was produced by translating,back translating,and adjusting the GES according to the process of Beaton,DE.Convenience sampling method was used to select patients with limb disabilities over 18 years old from Shanghai YangZhi rehabilitation hospital as research object.The factor validi-ty,discriminant validity,convergent validity,confirmatory factor analysis(CFA)and exploratory structural equa-tion model(ESEM)were evaluated by Mplus 8.3.Adopt Cronbach's α coefficient and McDonald's ω coeffi-cient were used for reliability test of the scale.The floor and ceiling effects were used to evaluate the respon-siveness of the scale.Result:Total 274 valid samples with limb disabilities were obtained.The Chinese version GES consisted of 15 items,with 3 items connected to each dimension:Knowledge and understanding,personal control,identity,shared decision-making,and Enabling others.The Cronbach's α of total scale as well as the five dimensions ranged from 0.759-0.896.The McDonald's ω ranged from 0.737-0.953 in CFA and ESEM.CFA,ESEM,and second-order confirmatory factor analysis model all fitted well.The ESEM's fit indices(χ2/df=1.113,RMSEA=0.020,TLI=0.994,CFI=0.998,SRMR=0.014)were significantly better than the CFA's fit indices(χ2/df=1.516,RM-SEA=0.043,TLI=0.972,CFI=0.978,SRMR=0.042).The Chinese version GES had good discriminate and con-vergent validity,and responsiveness was good.Conclusion:The various indicators of the Chinese version GES meet the requirements of psychometrics and can be used in the mental study of adult limb disability rehabilitation patients.

Many female patients with inflammatory bowel disease (IBD) are of reproductive age, and addressing fertility-related issues is an important part of comprehensive treatment. Although the fertility of female IBD patients does not differ significantly from that of the general population, many women with IBD opt for childlessness. This voluntary childlessness may stem from concerns about the adverse effects of IBD and its treatment on fertility, pregnancy, and newborns. A lack of in depth understanding of fertility, socioeconomic status, demographic factors, and insufficient professional medical advice may also contribute to patients' decision to choose voluntary childlessness. This article analyzes the factors influencing voluntary childlessness in female IBD patients and summarizes recommendations aimed at reducing trend, to enhance fertility awareness among female IBD patients and providing useful references for developing reasonable fertility plans.

Objective·To investigate the role of interleukin-1β(IL-1β)in predicting the severity of oral and maxillofacial space infection(OMSI),and to explore the key mechanisms regulating IL-1β release,the critical immune cell subpopulations involved,and the intercellular communication networks among immune cells in OMSI patients.Methods·A total of 62 OMSI patients admitted to the Department of Oral Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,from January to November 2023 were enrolled,including 20 patients with moderate infection,21 with severe infection,and 21 with extremely severe infection.Logistic regression analysis was performed to identify risk factors for extremely severe infection,and receiver operating characteristic(ROC)curves were constructed to evaluate the ability of the above indicators to predict extremely severe infection.Peripheral blood mononuclear cells(PBMCs)from 2 patients in each group(moderate,severe and extremely severe)and 2 healthy controls(GSE224198)were analyzed using single-cell RNA sequencing(scRNA-seq)to identify key pro-inflammatory cell subtypes and genes,and to examine their changing trends with increasing infection severity.Cell-cell communication was assessed using CellChat.Quantitative real-time polymerase chain reaction(qPCR)and Western blotting were used to validate inflammasome activation levels in PBMCs.Results·Compared with patients with moderate and severe infections,levels of procalcitonin(PCT)(P<0.05)and IL-1β(P<0.05)were significantly elevated in patients with extremely severe infection.Logistic regression identified IL-1β as an independent risk factor for extremely severe infection(OR=1.814,95%CI 1.256?2.621,P=0.002).The area under the ROC curve(AUC)for the combined prediction of extremely severe infection using IL-1β and PCT was 0.943.scRNA-seq revealed continuous upregulation of NLRP3(NOD-like receptor family pyrin domain-containing 3)and IL1B gene expression in monocytes as infection severity increased,with intermediate monocytes being the main IL1B-expressing cell subtype.IL-1Β-IL-1R signaling,C-C motif chemokine ligand(CCL)and intercellular adhesion molecule(ICAM)signaling were significantly enhanced in monocytes.Macrophage migration inhibitory factor(MIF)signaling between T cells and monocytes also increased notably.With infection progression,the mRNA levels of NLRP3 and IL1B in peripheral blood rose steadily,and the protein levels of NLRP3,caspase-1 p20,apoptosis-associated speck-like protein containing a CARD(ASC)and IL-1β were persistently elevated.Conclusion·The combined levels of IL-1β and PCT at admission can effectively predict extremely severe OMSI.NLRP3 inflammasome activation is observed in PBMCs of OMSI patients.The elevation of IL-1β is closely associated with intermediate monocytes.Monocyte-mediated IL-1Β-IL-1R,CCL and ICAM signaling pathways,along with T cell-mediated MIF signaling pathways,collectively promote the inflammatory response.

Objective·To investigate the role of interleukin-1β(IL-1β)in predicting the severity of oral and maxillofacial space infection(OMSI),and to explore the key mechanisms regulating IL-1β release,the critical immune cell subpopulations involved,and the intercellular communication networks among immune cells in OMSI patients.Methods·A total of 62 OMSI patients admitted to the Department of Oral Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,from January to November 2023 were enrolled,including 20 patients with moderate infection,21 with severe infection,and 21 with extremely severe infection.Logistic regression analysis was performed to identify risk factors for extremely severe infection,and receiver operating characteristic(ROC)curves were constructed to evaluate the ability of the above indicators to predict extremely severe infection.Peripheral blood mononuclear cells(PBMCs)from 2 patients in each group(moderate,severe and extremely severe)and 2 healthy controls(GSE224198)were analyzed using single-cell RNA sequencing(scRNA-seq)to identify key pro-inflammatory cell subtypes and genes,and to examine their changing trends with increasing infection severity.Cell-cell communication was assessed using CellChat.Quantitative real-time polymerase chain reaction(qPCR)and Western blotting were used to validate inflammasome activation levels in PBMCs.Results·Compared with patients with moderate and severe infections,levels of procalcitonin(PCT)(P<0.05)and IL-1β(P<0.05)were significantly elevated in patients with extremely severe infection.Logistic regression identified IL-1β as an independent risk factor for extremely severe infection(OR=1.814,95%CI 1.256?2.621,P=0.002).The area under the ROC curve(AUC)for the combined prediction of extremely severe infection using IL-1β and PCT was 0.943.scRNA-seq revealed continuous upregulation of NLRP3(NOD-like receptor family pyrin domain-containing 3)and IL1B gene expression in monocytes as infection severity increased,with intermediate monocytes being the main IL1B-expressing cell subtype.IL-1Β-IL-1R signaling,C-C motif chemokine ligand(CCL)and intercellular adhesion molecule(ICAM)signaling were significantly enhanced in monocytes.Macrophage migration inhibitory factor(MIF)signaling between T cells and monocytes also increased notably.With infection progression,the mRNA levels of NLRP3 and IL1B in peripheral blood rose steadily,and the protein levels of NLRP3,caspase-1 p20,apoptosis-associated speck-like protein containing a CARD(ASC)and IL-1β were persistently elevated.Conclusion·The combined levels of IL-1β and PCT at admission can effectively predict extremely severe OMSI.NLRP3 inflammasome activation is observed in PBMCs of OMSI patients.The elevation of IL-1β is closely associated with intermediate monocytes.Monocyte-mediated IL-1Β-IL-1R,CCL and ICAM signaling pathways,along with T cell-mediated MIF signaling pathways,collectively promote the inflammatory response.

Horseshoe anal fistula is one of the most challenging subtypes of complex anal fistulas, closely related to the failure of anal fistula surgery and postoperative recurrence. Accurate preoperative assessment, correct classification, and appropriate surgical plans are crucial for improving treatment efficacy. This article primarily explores the clinical classification of horseshoe anal fistulas and the applicability of mainstream surgical techniques in different types of horseshoe anal fistulas, focusing on their cure rates, recurrence rates, and fecal continence, to assist surgeons to make reasonable surgical plans when treating horseshoe anal fistulas.

ObjectiveTo explore the effect and possible molecular mechanism of Qinghua Yichang Formula （清化益肠方， QYF） in treating acute radiation-induced intestinal injury mice via NOD-like receptor thermal protein domain associated protein 3 （NLRP3）. MethodsSixty C57BL/6J mice were randomly divided into control group， model group， pre-modeling medication group， post-modeling medication group， inhibitor group， and QYF plus inhibitor group， with 10 mice in each group.Except for the control group， the other five groups were irradiated with a single full dose to establish the acute radiation-induced intestinal injury mice model. The pre-modeling medication group and the QYF plus inhibitor group were continuously given 4 g/ml of QYF decoction by gavage before modeling， 0.2 ml each time， once a day for 7 days. The post-modeling medication group， pre-modeling medication group and QYF plus inhibitor group were given 4 g/ml of QYF decoction for 14 days after modeling. The control group， model group and inhibitor group were given 0.2 ml of normal saline once a day for 14 consecutive days. Two hours after irradiation， the inhibitor group and the QYF plus inhibitor group were given an intraperitoneal injection of 0.2 ml of the NLRP3 inhibitor MCC950 （concentration： 10 mg/kg）， once every two days. To observe the pathological changes in intestinal tissues， hematoxylin-eosin （HE） staining was used. Western blotting and RT-qPCR were used to detect the protein and mRNA expression levels of NLRP3 in intestinal tissues. Immunohistochemistry was used to detect the expression level of NLRP3， Caspase-1 and GSDMD in intestinal tissues. The proportion of CD4⁺ and CD8⁺ T cells in the spleens of mice were detected by flow cytometry. ELISA was used to determine the levels of IFN-γ， IL-18， and IL-1β in mice serum. ResultsHE staining showed no lesions in the intestinal tissue of mice in the control group. The mice in the model group had shortened intestinal villi， thinned mucosal layers， multifocal mucosal necrosis in the lamina propria， and local neutrophil infiltration. The pathological damage of intestinal tissue of mice in each medication group was improved to varied degrees， among which the QYF plus inhibitor group showed most obvious improvement. Compared to those in the control group， the protein and mRNA expression levels of NLRP3 in the intestinal tissue of mice in the model group significantly increased， with higher NLRP3， Caspase-1， and GSDMD protein expression in the intestinal tissue， increased proportion of CD4⁺ T cells in spleen， decreased proportion of CD8⁺ T cells， and increased levels of IFN-γ， IL-18 and IL-1β in serum （P＜0.05）. Compared to those in the model group， the above indicators in the other medication groups were all improved （P＜0.05）.The NLRP3， Caspase-1， and GSDMD proteins in the pre-modeling medication group were lower than those in the post-modeling medication group （P＜0.05）； and the NLRP3 mRNA level in the QYF plus inhibitor group was lower than that in the inhibitor group （P＜0.05）. ConclusionQYF may play a role in preventing and treating acute radiation-induced intestinal injury by inhibiting the expression of NLRP3.