ObjectiveTo observe the effect of Liuwei Dihuangwan on behavioral impairments in the rat model of autism spectrum disorder （ASD） and explore the mechanism of action. MethodsTwelve SD pregnant rats were intraperitoneally injected with valproic acid （VPA） （10 rats） or normal saline （2 rats）， and male offspring were selected to establish the model of ASD and the control rats. Rats were randomly assigned into model， low-dose （0.75 g·kg^-1） and high-dose （1.5 g·kg^-1） Liuwei Dihuangwan， vitamin D （positive drug， 3.7×10^-5 g·kg^-1）， and blank groups. Each group was administrated with the corresponding concentration of drugs or the same volume of normal saline by gavage for 2 weeks. After the intervention， the three-chamber social test was conducted to evaluate social interaction and social preference. The open field test was carried out to observe spontaneous behavior and anxiety state. Hematoxylin-eosin staining （HE） was used to observe the pathological changes of the prefrontal tissue. Transmission electron microscopy was employed to observe the ultrastructure of mitochondria in prefrontal neurons. Immunofluorescence was used to detect the expression of ionized calcium-binding adapter molecule-1 （Iba-1） in the prefrontal tissue. Enzyme-linked immunosorbent assay （ELISA） was adopted to measure the levels of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6）. Western blot was employed to assess the expression differences of phosphorylated adenosine monophosphate-activated protein kinase （p-AMPK）， adenosine monophosphate-activated protein kinase （AMPK）， phosphorylated Unc-51-like autophagy-activating kinase 1 （p-ULK1）， Unc-51-like autophagy-activating kinase 1 （ULK1）， and FUN14 domain-containing protein 1 （FUNDC1）. ResultsCompared with the blank group， the model group spent less time sniffing stranger 1 and stranger 2 in the three-chamber social test （P<0.01） and showed reductions in the total distance traveled， average speed， distance traveled in the central area， and time spent in the central area in the open field test （P<0.01）. In addition， the model group showed extensive apoptosis of neurons， with shrunken nuclei and red-stained cytoplasm， and extensive necrosis of neurons in the prefrontal tissue， mitochondrial swelling， decreased matrix density， disrupted cristae， and autophagic lysosomes in neurons， increases in the rate of Iba-1 positive cells in the prefrontal area （P<0.01） and the levels of TNF-α and IL-6 （P<0.01）， and down-regulation in the expression of p-AMPK/AMPK， p-ULK1/ULK1， and FUNDC1 （P<0.01）. Compared with the model group， low-dose and high-dose Liuwei Dihuangwan and the vitamin D prolonged the time spent sniffing stranger 1 and stranger 2 in the three-chamber social test （P<0.05， P<0.01）， increased the total distance traveled， average speed， distance traveled in the central area， and time spent in the central area in the open field test （P<0.05， P<0.01）， restored the morphology of neurons in the prefrontal tissue， decreased the number of apoptotic cells， alleviated the swelling of mitochondria in neurons， increased the matrix density， mitigated the fragmentation and disorder of cristae， and increased the number of autophagosomes. Moreover， the drugs decreased the rate of Iba-1 positive cells in the prefrontal area （P<0.01）， lowered the levels of TNF-α and IL-6 （P<0.01）， and up-regulated the expression of p-AMPK/AMPK， p-ULK1/ULK1， and FUNDC1 （P<0.01）. ConclusionLiuwei Dihuangwan ameliorate autism-like behaviors and reduce neuronal apoptosis and neuroinflammatory damage in the rat model of ASD by promoting mitophagy mediated by the AMPK/ULK1/FUNDC1 pathway.

Yttrium-90 microsphere selective internal radiation therapy (SIRT), also known as transarterial radioembolization, has become one of the pivotal treatments for liver cancer, particularly for selected advantageous patient groups. This review summarizes the characteristics of different patients with liver cancer that could obtain maximum benefit from SIRT and discusses key factors affecting efficacy and safety, including tumor characteristics, liver function, patient performance status, and treatment intent. In evaluating appropriate candidates, mapping serves as a crucial simulation procedure to assess tumor vascular anatomy, predict lung shunting, and guide catheter positioning and dose planning. This procedure substantially enhances therapeutic precision while minimizing the risk of nontarget radiation-related adverse events, such as radiation-induced pneumonitis and gastrointestinal toxicity. Several studies have suggested that SIRT is not only suitable for patients with early or limited hepatocellular carcinoma but can also be used as a bridging therapy for liver transplantation and conversion therapy for unresectable liver cancers. In combination with systemic treatments, SIRT has demonstrated survival benefits in patients with unresectable liver cancer. This review also highlights the importance of further optimizing patient screening through personalized dosimetry and mapping to ensure the precision and safety of treatment. A thorough review of relevant literature and clinical practice offers clinicians comprehensive suggestions on patient screening and clarifies the promise of SIRT in the liver cancer population.

ObjectiveTo investigate the efficacy of Xingpi capsules （XPC） in treating diarrhea-predominant irritable bowel syndrome （IBS-D） with spleen deficiency and elucidate its potential molecular mechanisms. MethodsA rat model of IBS-D with spleen deficiency was established by administering senna leaf in combination with restrained stress and swimming fatigue for 14 d. Ten specific pathogen free （SPF）-grade healthy rats were used as the normal control group. After successful modeling， SPF-grade rats were randomly divided into a model group， a pinaverium bromide group （1.5 mg·kg^-1）， and low- and high-dose XPC groups （0.135 and 0.54 g·kg^-1）， with 10 rats in each group. Rats in the normal control group and the model group were given distilled water by gavage， while the remaining groups were administered corresponding drug solutions by gavage once a day for 14 consecutive days. The rat body weights and fecal condition were observed every day， and the Bristol score was recorded. Enzyme-linked immunosorbent assay （ELISA） was used to determine the levels of 5-hydroxytryptamine （5-HT） in serum and colon tissue. Transmission electron microscopy was used to observe the microvilli and tight junctions in the colon. The integrity of the colonic barrier， intestinal motility， and expression of related pathway proteins were evaluated by hematoxylin-eosin （HE） staining， immunohistochemistry， and Western blot. ResultsCompared with those in the normal control group， rats in the model group showed a significantly decreased body weight and increased diarrhea rate， diarrhea grade， and Bristol score （P<0.01）. HE staining revealed incomplete colonic mucosa in the model group， with evident congestion and edema observed. Electron microscopy results indicated decreased density and integrity of the colonic barrier， shedding and disappearance of microvilli， and significant widening of tight junctions. The expression levels of colonic tight junction proteins Occludin and Claudin-5 were downregulated （P<0.01）， and the levels of 5-HT in serum and colon tissue were elevated （P<0.01）. The small intestine propulsion rate significantly increased （P<0.01）， and the expression of contractile proteins Ras homolog family member A （RhoA） and Rho-associated coiled-coil containing protein kinase 2 （ROCK2） in colon and phosphorylation of myosin light chain （MLC₂₀） were upregulated （P<0.01）. Compared with the model group， the treatment groups showed alleviated diarrhea， diarrhea-associated symptoms， and pathological manifestations of colon tissue to varying degrees. Specifically， high-dose XPC exhibited effectively relieved diarrhea， promoted recovery of colonic mucosal structure， significantly reduced congestion and edema， upregulated expression of Occludin and Claudin-5 （P<0.01）， decreased levels of 5-HT in serum and colon tissue （P<0.05，P<0.01）， significantly slowed small intestine propulsion rate （P<0.01）， and significantly downregulated expression of contractile proteins RhoA and ROCK2 in colon and phosphorylation of MLC₂₀ （P<0.05，P<0.01）. ConclusionXPC effectively alleviates symptoms of spleen deficiency and diarrhea and regulates the secretion of brain-gut peptide. The characteristics of XPC are mainly manifested in alleviating IBS-D with spleen deficiency from the aspects of protecting intestinal mucosa and inhibiting smooth muscle contraction， and the mechanism is closely related to the regulation of the 5-HT-RhoA/ROCK2 pathway expression.

The incidence and mortality of hepatocellular carcinoma (HCC) in China are among the highest in the world, imposing a heavy social burden. Liver resection and liver transplantation are the primary radical treatments for HCC, although most patients are no longer able to meet the surgical requirements at initial diagnosis. Yttrium-90 microsphere selective internal radiation therapy (⁹⁰Y-SIRT) has the advantages of shrinking tumors, enlarging residual liver, regressing portal vein tumor thrombus and improving the quality of life, which can be used for conversion, downstaging and bridging therapy for HCC before surgical treatment, enabling patients regain the chance of radical treatment and reducing the postoperative recurrence rate. This review focuses on the clinical application and progress of ⁹⁰Y-SIRT in this field.

Objective:To explore the relationship between general demographic characteristics,inflammatory indicators,nutritional indicators,pathological data and lymph node metastasis in endometrial cancer(EC)pa-tients,and to construct and validate a model for preoperative prediction of lymph node status in endometrial canc-er patients.Methods:The preoperative clinical data of 473 patients with EC who underwent surgical treatment in the Zhu Jiang Hospital of Southern Medical University from January 2010 to April 2024 were retrospectively ana-lyzed.The independent risk factors of lymph node metastasis of endometrial cancer were screened by univariate and multivariate Logistic regression analyses,and the nomogram prediction model was constructed by R soft-ware.The performance of the model was evaluated by the receiver operating characteristic(ROC)curve,calibra-tion curve and clinical decision curve.Results:Menopausal status,high grade biopsy pathology,CA125 ≥24.47U/ml,systemic immune inflammatory index(SII)≥710.91,and prognostic nutritional index(PNI)＜52.90 were in-dependent risk factors for lymph node metastasis in endometrial cancer(OR＞1,P＜0.05).The nomogram model constructed based on these five factors had an AUC of 0.853 in the training set and 0.871 in the test set.The cali-bration curve fitted well,and the clinical decision curve shows a positive benefit.Conclusions:The endometrial cancer lymph node metastasis prediction model constructed based on menopausal status,biopsy pathology,CA125,SII,and PNI has good accuracy and fit,with certain clinical application value.

A 36-year-old male developed unconsciousness and no response to voice stimuli after taking approximately 2 050 mg felodipine (the specific time was unknown). Two hours later, he was sent to the department of emergency by his family and admitted to the hospital. His vital signs showed body temperature 35.1 ℃, pulse 148 times/min, respiration 32 times/min, and blood pressure 65/34 mmHg. Acute drug poisoning, acute toxic cardiomyopathy, acute toxic shock, acute type Ⅱ respiratory failure, acute toxic encephalopathy, and acute renal failure were diagnosed based on the patient′s clinical manifestations combined with laboratory tests results, cardiac ultrasound, chest and abdominal CT scans. Endotracheal intubation connected to a ventilator for invasive assisted ventilation, pressure boosting, and fluid resuscitation were given. At the same time, repeated gastric lavage and enema were performed to remove toxins. Blood perfusion was intermittently and repeatedly administered, and continuous renal replacement therapy was used. The blood concentration of felodipine was 1 298 μg/L at 2 hours after admission, and cardiac arrest occurred at 4 hours. Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) treatment was administered immediately. After 48 hours of ECMO operation, sedatives were discontinued and the patient′s consciousness was improved after 4 hours. On the 5th day of ECMO treatment, his heart rate was 72 beats per minute, and blood pressure was 127/65 mmHg. The blood concentration of felodipine decreased to 2 μg/L. The patient′s vital signs were significantly improved and ECMO supportive treatment was withdrawn. After 26 days of hospitalization, the patient recovered and was discharged.

Objective:To systematically evaluate the effect of virtual reality exercise training on gait performance in older adults.Methods:Randomized controlled trials on the rehabilitation effects of virtual reality exercise training on gait performance in older adults were electronically searched in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc. The search period was from establishing of the database to January 10, 2025. Version 2 of the Cochrane risk of bias tool for randomized trials (RoB 2) was used to evaluate the methodological quality of the included literature. Meta-analysis was performed using RevMan 5.4.Results:A total of 27 articles were included. Meta-analysis showed that the effect of virtual reality exercise on improving the functional walking ability of older adults was better than traditional exercise [ WMD=-0.83, 95% CI (-1.31, -0.36) , P<0.01]. However, virtual reality exercise did not improve step speed, stride length, step frequency, and dynamic gait indices in older adults ( P>0.05) . Subgroup analysis showed that virtual reality exercise was more effective than traditional exercise in improving step speed in older adults when the length of the weekly intervention was≥120 min [ SMD=0.48, 95% CI (0.04, 0.92) , P=0.03]. Conclusions:Virtual reality exercise training effectively improves walking ability in older adults but has no advantage in improving refined gait-related indicators. Future interventions in the form of virtual reality exercise training combined with traditional exercise rehabilitation are recommended for older adults.

Objective:To construct a curriculum system for malignant fungating wounds based on Kolb experience learning theory.Methods:The first draft of a curriculum system for malignant fungating wounds was constructed based on literature search and group discussion using Kolb experience learning theory as a guide. Between February and May 2024, purposive sampling was used to select 16 experts for two rounds of expert consultation based on the Delphi method to form the final draft of the curriculum system for malignant fungating wounds.Results:A total of 16 questionnaires were distributed in both rounds of expert consultation and 16 questionnaires were effectively recovered with an effective recovery rate of 100.00%. The expert authority coefficients in two rounds of consultation were all 0.916, and Kendall's W values ranged from 0.089 to 0.192 (all P<0.05). The final curriculum system for malignant fungating wounds included four primary indicators, 10 secondary indicators, and 32 tertiary indicators. Conclusions:The curriculum system for malignant fungating wounds constructed under the guidance of Kolb experience learning theory is scientific and practical, and can provide a basis for conducting malignant fungating wound training.

Objective:To retrospectively seek any correlation between hemoglobin (Hb) levels and post-stroke cognitive impairment (PSCI), and to explore the value of Hb levels in PSCI diagnosis and prediction.Methods:The Mini-mental State Examination (MMSE) was used to sort elderly persons who had suffered a first stroke into a PSCI group showing cognitive impairment and a PSNCI group which was not cognitively impaired. Healthy counterparts undergoing physical examinations were selected into a healthy group. Everyone′s white blood cell count (WBC), neutrophil count (NC), lymphocyte count (LC), monocyte count (MONO), platelet count (PLT) and Hb, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were recorded. Monocyte to high density lipoprotein cholesterol ratios (MHRs), neutrophil to lymphocyte ratios (NLRs), and platelet to lymphocyte ratios (PLRs) were calculated. The differences among the three groups were compared seeking to identify risk factors predicting PSCI.Results:There were no significant differences in age, gender, WBC, MONO, PLT, TG or MHR among the three groups, on average. But there were significant differences in NC, LC, Hb, TC, HDL-C, LDL-C, NLR and PLR. Spearman correlation analysis showed that NC, NLR and PLR were negatively correlated with the average MMSE score, while LC, Hb, TC, HDL-C and LDL-C were positively correlated with it. Logistic regression analysis showed that a low level of Hb was an independent risk factor for PSCI for the elderly stroke survivors. The area under the receiver operating characteristics curve (AUC) for Hb was 0.794 for predicting PSCI in elderly stroke patients, with a maximum Youden index of 0.496. The critical value of Hb was estimated as 138.5g/L.Conclusions:Hb levels can significantly predict the cognitive functioning of elderly stroke survivors. An Hb level below 138.5g/L is an independent risk factor for PSCI, while higher Hb levels may indicate cognitive benefits.

Objective:To retrospectively seek any correlation between hemoglobin (Hb) levels and post-stroke cognitive impairment (PSCI), and to explore the value of Hb levels in PSCI diagnosis and prediction.Methods:The Mini-mental State Examination (MMSE) was used to sort elderly persons who had suffered a first stroke into a PSCI group showing cognitive impairment and a PSNCI group which was not cognitively impaired. Healthy counterparts undergoing physical examinations were selected into a healthy group. Everyone′s white blood cell count (WBC), neutrophil count (NC), lymphocyte count (LC), monocyte count (MONO), platelet count (PLT) and Hb, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were recorded. Monocyte to high density lipoprotein cholesterol ratios (MHRs), neutrophil to lymphocyte ratios (NLRs), and platelet to lymphocyte ratios (PLRs) were calculated. The differences among the three groups were compared seeking to identify risk factors predicting PSCI.Results:There were no significant differences in age, gender, WBC, MONO, PLT, TG or MHR among the three groups, on average. But there were significant differences in NC, LC, Hb, TC, HDL-C, LDL-C, NLR and PLR. Spearman correlation analysis showed that NC, NLR and PLR were negatively correlated with the average MMSE score, while LC, Hb, TC, HDL-C and LDL-C were positively correlated with it. Logistic regression analysis showed that a low level of Hb was an independent risk factor for PSCI for the elderly stroke survivors. The area under the receiver operating characteristics curve (AUC) for Hb was 0.794 for predicting PSCI in elderly stroke patients, with a maximum Youden index of 0.496. The critical value of Hb was estimated as 138.5g/L.Conclusions:Hb levels can significantly predict the cognitive functioning of elderly stroke survivors. An Hb level below 138.5g/L is an independent risk factor for PSCI, while higher Hb levels may indicate cognitive benefits.