Idiopathic pulmonary fibrosis （IPF） is a chronic and fibrotic lethal interstitial lung disease with poor prognosis. It is mainly treated by organ transplantation and administration of chemical drugs， which have poor efficacy and induce side effects， failing to meet the clinical needs. Therefore， it is urgent to develop more safe and effective drugs to treat IPF. Traditional Chinese medicine （TCM） has garnered increasing attention in recent years in the treatment of IPF due to its unique advantages. Increasing studies have shown that TCM has remarkable therapeutic effects on IPF and thus demonstrate broad application prospects. Modern medical research shows that the pathogenesis of IPF can be discussed from inflammation （macrophage polarization）， oxidative stress， epithelial-mesenchymal transition （EMT）， autophagy inhibition and other related signaling pathways， while few studies systematically explain the relationship between the signaling pathways and TCM theory. According to the theory of TCM， lung collateral obstruction is the basic pathogenesis of IPF. Therefore， according to the principle of dredging and replenishing lung collaterals， IPF can be treated with the methods of reinforcing healthy qi and eliminating pathogen， replenishing qi and activating blood， and detoxifying and dredging collaterals， which demonstrate definite curative effect and can effectively relieve clinical symptoms， restore the lung function and blood oxygen partial pressure， improve the quality of life of patients， and reduce adverse reactions. Experimental studies have found that dredging and replenishing lung collaterals have significant effects on IPF inflammation （macrophage polarization）， oxidative stress， EMT， autophagy inhibition and other signaling pathways. Therefore， from the perspective of impediment， this article reviews pathogenesis of IPF， the research progress in TCM treatment of IPF， and the treatment of IPF from active components， single herbs， and compound prescriptions of TCM， with the aim of revealing the scientific connotation of the treatment of IPF from impediment and providing a new theoretical basis for enriching the TCM methods of treating IPF.

AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR), and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS: A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital, Sun Yat-sen University from 2022 to 2023 were included, including 95 first-diagnosed DR patients and 105 patients without DR, and all patients underwent OCTA examination and a collection of demographics and renal function parameters. After a quality check, automated measurements of the foveal avascular zone area, vessel density(VD), and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS: Using random forest and multivariate Logistic regression methods, we developed a diagnostic model for DR based on 12 variables(age, FBG, SBP, DBP, HbA1c, ALT, ALP, urea/Scr, DM duration, HUA, DN, and CMT). Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window, AUC=0.837 vs 0.819, P=0.03). In the study of DN patients, the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD; outer VD; full VD; outer PD; full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model. Meanwhile, compared with the 3 mm×3 mm window, the microvascular parameters in the 6 mm× 6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.

Objective: To explore the feasibility of synthetic magnetic resonance imaging (syMRI) combined with clinicopathological characteristics for the pre-treatment prediction of chemoradiotherapy (CRT) response in advanced nasopharyngeal carcinoma (ANPC). Materials and Methods: Patients with ANPC treated with CRT between September 2020 and June 2022 were retrospectively enrolled and categorized into response group (RG, n = 95) and non RGs (NRG, n = 32) based on the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The quantitative parameters from pre-treatment syMRI (longitudinal [T1] and transverse [T2] relaxation times and proton density [PD]), diffusion-weighted imaging (apparent diffusion coefficient [ADC]), and clinicopathological characteristics were compared between RG and NRG. Logistic regression analysis was applied to identify parameters independently associated with CRT response and to construct a multivariable model. The areas under the receiveroperating characteristic curve (AUC) for various diagnostic approaches were compared using the DeLong test. Results: The T1, T2, and PD values in the NRG were significantly lower than those in the RG (all P < 0.05), whereas no significant difference was observed in the ADC values between these two groups. Clinicopathological characteristics (Epstein–Barr virus [EBV]-DNA level, lymph node extranodal extension, clinical stage, and Ki-67 expression) exhibited significant differences between the two groups. Logistic regression analysis showed that T1, PD, EBV-DNA level, clinical stage, and Ki-67 expression had significant independent relationships with CRT response (all P < 0.05). The multivariable model incorporating these five variables yielded AUC, sensitivity, and specificity values of 0.974, 93.8% (30/32), and 91.6% (87/95), respectively. Conclusion SyMRI may be used for the pretreatment prediction of CRT response in ANPC. The multivariable model incorporating syMRI quantitative parameters and clinicopathological characteristics, which were independently associated with CRT response, may be a new tool for the pretreatment prediction of CRT response.

Objective To investigate the anti-tumor effect of Job's tears oral solution on lung cancer mice.Methods Observe the histopathological morphology of the tumor;Flow cytometry detected the changes in the levels of CD4+T and CD8+T in splenic lymphocytes;Elisa detected the contents of immunoglobulins IgA,IgG,IL-2 and IFN-γ;Blood routine was detected;the kit determined the levels of liver and kidney glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)and malondialdehyde(MDA)content;Serum alanine aminotransferase(ALT),alkaline phosphatase(ALB),azelaic transaminase(AST),urea nitrogen(BUN),and blood creatinine(CRE)were measured in each group of mice.The transcriptome was found differential genes and pathway enrichment was performed.Western blot was used to detect the expression of proteins related to IL-17 signaling pathway(STAT3,NF-κB,VEGF)and TNF signaling pathway(PI3K/AKT,MAPK,JNK).Results Tumor histopathological and morphological changes were obvious in each administration group,and the heterogeneity was gradually reduced.Compared with the cisplatin group,the levels of CD4+T,CD8+T,CD4+T/CD8+T,IL-2,IFN-γ,and IgG in the Job's tears group were significantly increased(P<0.01).The blood routine results:compared with the model group,WBC,RBC,HGB,PLT,Lym%and GR%in the Job's tears group decreased significantly(P<0.01);Compared with the cisplatin group,WBC,RBC,PLT,HGB and Lym%in the Job's tears group increased significantly(P<0.01).The antioxidant indexes of liver and kidney showed that the levels of GSH and SOD in the liver and kidney tissues of the Job's tears group increased significantly(P<0.01),and the level of MDA decreased significantly(P<0.01).Effects on liver and kidney function indexes in mice AST,ALT,BUN and CRE decreased significantly in the Job's tears group(P<0.01),and ALB level increased significantly in the Job's tears group(P<0.01).Transcriptome results,Job's tears high-dose group mainly exerted anti-tumor effects by affecting TNF signaling pathway and IL-17 signaling pathway.Western blot results,in the IL-17 signaling pathway,S-TAT3 and VEGF decreased in the cisplatin group and the Job's tears group compared with the model group(P<0.01),and NF-κB decreased in the Job's tears high-dose group(P<0.01);Compared with the cisplatin group,STAT3 and NF-κB were decreased in the Job's tears group(P<0.01);VEGF was decreased in the Job's tears low-dose group(P<0.01);In the TNF signaling pathway,PI3K and MAPK were decreased in the cisplatin group and Job's tears group(P<0.01);AKT and P-AKT were decreased in the Job's tears group(P<0.01).Compared with the cisplatin group,the Job's tears group AKT,PI3K,and MAPK decreased(P<0.01);P-AKT decreased in the high dose group of Job's tears(P<0.01).Conclusion High-dose Job's tears oral solution inhibits tumor proliferation,attenuates inflammatory response,enhances immunity,improves blood routine and reduces liver and kidney injury in lung cancer mice mainly by inhibiting IL-17 and TNF signaling pathway.

Objective·To evaluate the feasibility and diagnostic performance of diffusion-relaxation correlation spectroscopic imaging(DR-CSI)in assessing the heterogeneity of benign and malignant head and neck tumors,as well as in identifying occult lymph node metastasis(OLNM).Methods·A prospective study was conducted from January to December 2024 at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,enrolling patients with suspected head and neck tumors who were scheduled for surgery and had a confirmed pathological diagnosis.All patients underwent preoperative routine head and neck plain and contrast-enhanced magnetic resonance imaging(MRI)examinations,including DR-CSI sequence.Conventional imaging parameters,including maximal diameter(MD),depth of invasion(DOI)for tumors,and MD and short diameter(SD)for lymph nodes,were obtained.Post-processing was performed to obtain apparent diffusion coefficient(ADC),T2 value,and D-T2 spectra for all lesions.The compartment segmentation strategy was optimized based on the spectral peak distribution characteristics of different diseases,and the volume fraction(Vi)of each compartment was obtained.Independent sample t-tests,Mann-Whitney U tests,chi-square tests,or Fisher's exact tests were used to compare intergroup differences in clinical data and imaging metrics.Principal component analysis(PCA)and Adonis analysis were employed to evaluate the discriminative ability of imaging metrics among different subtypes of benign tumors.Receiver operating characteristic(ROC)analysis was used to evaluate the ability of univariate and multivariable models to characterize the malignancy of head and neck squamous cell carcinoma(HNSCC)and identify OLNM.Results·A total of 97 cases were collected,including 28 benign tumors and 69 HNSCCs.Fifteen pathologically confirmed OLNMs and 20 benign lymph nodes(BLNs)were also enrolled.Among the 28 benign tumors,there were 6 cases of pleomorphic adenoma stroma-rich(PA stroma-rich),9 cases of pleomorphic adenoma stroma-poor(PA stroma-poor),9 cases of Warthin's tumor(WT),and 4 cases of basal cell adenoma(BCA).Statistically significant differences were observed in certain imaging parameters(ADC,T2,and DR-CSI Vi)among benign tumor subtypes.PCA analysis demonstrated a strong discriminative ability of imaging parameters in distinguishing pathological subtypes of benign tumors(R2=0.64,P<0.001).Among the 69 HNSCCs,47 were classified as Grade 1(well/moderately well-differentiated)and 22 as Grade 2(moderately/poorly differentiated).Compared to Grade 1,Grade 2 showed lower ADC and higher T2 values,though differences were not statistically significant.As HNSCC malignancy increased,VA4 decreased and VB4 increased significantly.OLNM showed a significant increase in SD and VA4 compared to BLNs.The combination of SD and VA4 for preoperative OLNM identification achieved a diagnostic efficiency of 0.843.Conclusion·DR-CSI can analyze diffusion and relaxation characteristics at the sub-voxel level,offering valuable insights for characterizing benign head and neck tumor subtypes,assessing HNSCC malignancy,and identifying OLNMs.Compared to traditional parameters like ADC or T2,DR-CSI provides enhanced tissue microstructure analysis.

Objective:To explore the potential categories of symptom characteristics of early breast cancer patients undergoing postoperative chemotherapy, analyze the differences of symptoms among different categories of patients, and compare their quality of life according to different categories.Methods:This was a cross-sectional study. From January to June 2023, 240 patients with early breast cancer who received chemotherapy after surgery in General Hospital of Ningxia Medical University were selected by convenience sampling. They were investigated by general information questionnaire, Memory Symptom Assessment Scale, and Functional Assessment of Caner Therapy-Breast Cancer. Mplus 8.3 was used to carry out potential profile analysis and identify the potential categories of symptom characteristics of early breast cancer patients undergoing postoperative chemotherapy. Binary Logistic regression analysis was used to determine the influencing factors of symptom characteristics. SPSS 26.0 software was used to compare the differences in quality of life scores of patients undergoing postoperative chemotherapy for different categories of early breast cancer.Results:Totally 233 valid questionnaires were ultimately collected, with an age of 50.85 ± 8.09. There were two potential categories of postoperative chemotherapy patients with early breast cancer: low symptom troubled group (159 cases, 68.2%) and high symptom troubled group (74 cases, 31.8%). The quality of life score of the high symptom distress group was (76.84 ± 13.15) points, which was significantly lower than (89.56 ± 11.29) points of the low symptom distress group, and the difference was statistically significant ( t=7.18, P<0.01). Logistic regression analysis showed that patients with early breast cancer who had financial burden after postoperative chemotherapy were more likely to belong to the group with high symptoms [ OR (95% CI) was 3.028 (1.434-6.394), P<0.01]. Postoperative chemotherapy patients with early breast cancer who had satisfactory sleep at night are more likely to belong to the group with low symptoms [ OR(95% CI) was 0.446 (0.217-0.920), P<0.05]. Conclusions:There is population heterogeneity in the symptom characteristics of patients with early breast cancer undergoing postoperative chemotherapy. and economic burden and night sleep are the influencing factors of symptom distress categories of breast cancer patients. It is suggested that medical staff should give individualized and targeted intervention measures centered on patients′ needs according to different types of population characteristics, so as to reduce the symptom burden and improve their quality of life.

The etiology of non-cirrhotic portal hypertension (NCPH) is complex and there is a lack of a clear pathogenesis. Early diagnosis is difficult, which is an important clinical challenge. The diagnosis of NCPH requires a combination of clinical features, risk factors and auxiliary examinations. Pathological biopsy is the key to a confirmed diagnosis. The treatment of NCPH focuses on tracing the cause of the disease as the core and individualized management of the primary disease and complications. In the future, a stratified diagnosis and treatment system based on multi-omics needs to be constructed to optimize prognosis management, thereby improving the long-term prognosis of patients with NCPH.

Objective:To explore the clinical characteristics of patients with porto-sinusoidal vascular disease (PSVD) complicated with esophageal and gastric varices, and to evaluate the effect of portal vein pressure (PVP) on esophageal and gastric varices bleeding and rebleeding after endoscopic treatment.Methods:Patients who were hospitalized in the Department of Gastroenterology of the Zhongshan Hospital, Fudan University due to portal hypertension from July 2022 to October 2024, underwent liver biopsy for diagnosis of PSVD, and received direct PVP measurement were included. Their clinical manifestations, liver histopathological characteristics were analyzed, and the prognosis was followed up.Results:A total of 29 patients were included, and 19 patients had experienced rupture and bleeding of esophageal and gastric varices. Compared with the non-bleeding group, the hemoglobin level of patients in the bleeding group was lower and the international normalized ratio was higher (all P<0.05). There was no statistically significant difference between the two groups in other laboratory examination indicators, complications of portal hypertension, combined diseases, etc. (all P>0.05). The pathology of liver biopsy suggests that dilation of the hepatic sinuses and abnormalities of the central vein are common pathological changes. The direct PVP of patients in the bleeding group was significantly higher than that in the non-bleeding group [28.0(24.5-31.0)mmHg vs 18.5(10.5-23.8)mmHg, P=0.011]. However, there was no statistically significant difference in the measured values of liver wedge pressure, free pressure and hepatic venous pressure gradient (HVPG) between the two groups of patients (all P>0.05). Correlation analysis revealed that there was no significant correlation between HVPG and PVP ( R2=0.129 9, P=0.076 7). Grouped according to the median PVP value of 25 mmHg, the risk of esophageal and gastric variceal rupture and bleeding in the high PVP group (≥25 mmHg) was significantly higher than that in the low PVP group (<25 mmHg) (14/16 vs 5/13, P=0.016). The risk of rebleeding after endoscopic treatment in patients with high PVP (4/13) was higher than that in patients with low PVP (0/4). Conclusions:Patients with porto-sinusoidal vascular disease complicated with portal hypertension are often accompanied by rupture and bleeding of esophageal and gastric varices. HVPG cannot accurately reflect the portal vein pressure. The risk of rupture and bleeding of esophageal and gastric varices and rebleeding in patients with elevated portal vein pressure is significantly increased.

Objective:To explore the effect of inflammatory cell levels on the anticoagulant efficacy in patients with liver cirrhosis complicated with portal vein thrombosis (PVT).Methods:A total of 106 patients with liver cirrhosis complicated with PVT who visited the Zhongshan Hospital, Fudan University from 2017 to 2022 were prospectively included. The PVT grade and recanalization were evaluated by imaging. Cox regression was used to analyze the predictive factors of anticoagulation efficacy. The time-dependent receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of inflammatory cells for predicting anticoagulation efficacy. The Kaplan-Meier method was used to compare the 1-year PVT recanalization rate of patients with different levels of inflammatory cells.Results:Univariate analysis showed that Child-Pugh score ( HR=1.41), D-dimer ( HR=0.98), platelet ( HR=0.98), C-reactive protein to lymphocyte ratio ( HR=1.01), monocyte ( HR=0.21), lymphocyte ( HR=0.34), and prothrombin time( HR=1.32) was related to the improvement of PVT (all P<0.05). Multivariate analysis confirmed that lymphocytes ( HR: 0.41, 95% CI: 0.20-0.85, P=0.016) and prothrombin time ( HR: 1.23, 95% CI: 1.01-1.50, P=0.036) were independent predictors of anticoagulant efficacy. Grouped according to the ROC cutoff value, the 1-year recanalization rate of PVT in the high-level lymphocyte group (4.55% vs 32.84%, P=0.012) and the high-level monocyte group (5.56% vs 31.4%, P=0.028) was significantly lower than that in the low-level group. After excluding patients undergoing splenectomy, the recurrence rate in the high-level lymphocyte group was still lower than that in the low-level group (6.25% vs 33.77%, P=0.038). Conclusions:Among patients with liver cirrhosis accompanied by PVT, high levels of lymphocytes and monocytes are the key factors for the poor efficacy of anticoagulation therapy. For PVT patients with poor anticoagulation efficacy, the therapeutic strategy of anti-inflammatory combined with anticoagulation can be considered for exploration in the future.

Objective:To analyze the application of Sengstaken-Blakemore tubes combined with endoscopic intervention on the prognosis of patients with acute esophageal and gastric variceal rupture and bleeding due to portal hypertension in liver cirrhosis, and to explore the impact of Sengstaken-Blakemore tubes combined with endoscopic intervention on the prognosis of patients.Methods:A retrospective study included patients with liver cirrhosis who visited the Zhongshan Hospital, Fudan University from January 2023 to July 2024 due to acute upper gastrointestinal bleeding, had no response to drug treatment and unstable hemodynamics, and received the Sengstaken-Blakemore tubes compression hemostasis. According to whether endoscopic intervention was received or not, the patients were divided into the endoscopic intervention group and the non-endoscopic intervention group. The medication and subsequent treatment of the patients were analyzed, and the survival of the patients 28 days after bleeding was followed up. Kaplan-Meier survival analysis and Cox regression analysis were used to evaluate the effect of endoscopic intervention on the 28-day mortality rate of patients.Results:A total of 31 cases successfully had three-lumen two-cystic tubes indwelled. Among them, 8 cases further received endoscopic examination and intervention, and 23 cases did not receive endoscopic examination. During the 28-day follow-up after bleeding, a total of 20 cases died. The Kaplan-Meier survival analysis showed that the 28-day mortality rate in the endoscopic intervention group was significantly lower than that in the non-endoscopic intervention group (25.0% vs 78.3%, P=0.007). Multivariate Cox regression analysis showed that endoscopic intervention was an independent protective factor for 28-day mortality ( HR: 0.14, 95% CI: 0.03-0.63, P=0.01). In addition, the severity of bleeding and prothrombin time were also important factors affecting the prognosis of patients. Conclusions:The Sengstaken-Blakemore tubes, as an important hemostasis method for acute esophageal and gastric variceal rupture and bleeding, can buy time for subsequent endoscopic treatment, but the risk of complications is relatively high. Creating conditions for early endoscopic intervention as early as possible can significantly reduce the mortality rate of patients and improve the prognosis of patients with liver cirrhosis.