Testicular radiation injury is a structural and functional abnormality of the testes caused directly or indirectly by radiation, which disrupts spermatogenesis and compromises male fertility. The development of effective preventive and therapeutic interventions is essential because of the high prevalence of this condition in clinical settings and its profound effect on patients′ reproductive health and overall well-being. The concept of "the struggle between vital qi and pathogen" is first seen in the Treatise on Cold Pathogenic Diseases. It denotes the dynamic struggle between vital and pathogenic qi. The occurrence, development, and sequelae of all diseases reflect this ongoing conflict. In this context, this study defines the "vital qi" of the testis as its capacity to generate and preserve the essence of reproduction and to resist damage. The pathogenic qi associated with testicular radiation injury is categorized into two types: ionizing poison and retaining evil. The pathogenesis of testicular radiation damage is delineated into three stages by integrating the characteristics of vital and pathogenic qi: the injury, adhesion, and recovery phases. Based on the theoretical framework advanced by this study, the therapeutic approach for testicular radiation injury should adhere to the fundamental principle of strengthening vital qi and eliminating pathogenic factors. Although the primary focus of treatment should be on strengthening vital qi, it should also be complemented by strategies to eliminate pathogenic influences. This paper aims to provide a novel perspective and strategic approach to the traditional Chinese medicine diagnosis, prevention, and treatment of testicular radiation injury. By elucidating the process of testicular radiation injury and its corresponding treatment principles, it seeks to offer valuable insights for clinical practice.

Objective With the continuous advancement of China's deep space exploration and space station construction missions,the issues of radiation protection and health security for astronauts in special space environments have become increasingly prominent,gradually emerging as a core research topic in the field of special medicine.To investigate the protective effect and mechanism of Fuping decoction against ionizing radiation-induced inflammatory damage to the immune system in mice,and to verify whether it relieves radiation-induced inflammatory injury by regulating macrophage M1/M2 polarization balance.Methods An in vivo radiation injury model was established using Balb/c mice.The expression levels of pro-inflammatory factors TNF-α and IL-6 in the spleen and thymus,and the phagocytic rate of peritoneal macrophages were detected.Mouse-derived macrophages were cultured in vitro to establish an in vitro radiation injury model.The secretion levels of inflammatory factors TNF-α,IL-6,and IL-10 were measured,macrophage polarization was observed by immunofluorescence,and the protein expression of the TLR4/MyD88/NF-κB signaling pathway was analyzed by Western blot.Results In vivo experiments showed that Fuping significantly reduced the phagocytic rate of peritoneal macrophages and the contents of TNF-α and IL-6 in the spleen and thymus of irradiated mice.In vitro experiments demonstrated that Fuping restored the M1/M2 polarization balance of macrophages,decreased the expression levels of TNF-α and IL-6,increased the expression of IL-10,and inhibited the protein expression of TLR4,MyD88,and NF-κB in irradiated macrophages.Conclusion Fuping alleviates radiation-induced inflammatory injury by inhibiting the TLR4/MyD88/NF-κB signaling pathway and regulating macrophage polarization balance,providing an experimental basis for the development of natural radioprotective drugs.

Objective To observe the protective effects of Yiqi Jiedu Decoction on ionizing radiation-induced small intestinal functional injury in mice,and explore whether it alleviates such injury by inhibiting small intestinal ferroptosis,thereby providing scientific support for the discovery and development of intestinal radiation protection drugs in aerospace medicine.Methods A total of 378 male Balb/c mice were randomly divided into 7 groups:blank control group,model group,positive drug group,high-dose Yiqi Jiedu Decoction group,low-dose Yiqi Jiedu Decoction group,Liproxstatin-1 pre-irradiation administration group,and Liproxstatin-1 post-irradiation administration group,with 54 mice in each group.Each group was further divided into 3 batches,with 18 mice per batch.Seven days after preventive administration,all groups except the blank control group were subjected to a single whole-body irradiation with 2.0 Gy 60Co γ-rays.The general condition and morphological structure of the small intestine were observed at 1,3,and 7 days post-irradiation.The small intestinal charcoal propulsion rate,serum D-xylose content,and lactic acid content were measured,along with the levels of Fe,LPO,MDA,GSH,and SOD activity in the small intestine.Results Yiqi Jiedu Decoction could mitigate the decrease in body weight of mice after 2.0 Gy 60Co γ-ray irradiation,improve the morphological structure of the small intestine,reduce the small intestine charcoal propulsion rate,increase serum D-xylose levels,and decrease total serum lactate levels.It also alleviated mitochondrial shrinkage in the small intestine and reduced the contents of Fe and MDA in small intestine tissues.Conclusion Yiqi Jiedu Decoction may alleviate ionizing radiation-induced small intestinal functional injury by inhibiting ferroptosis in the small intestine,providing a new strategy for intestinal radiation injury in deep space exploration missions such as manned spaceflight.

Objective To investigate the regulatory effect and mechanism of Yiqi Jiedu Decoction(YQJD)on ionizing radiation-induced macrophage polarization and its correlation with the Toll-like receptor 4(TLR4)/myeloid differentiation primary response protein 88(MyD88)/nuclear factor kappa-B(NF-κB)signaling pathway.Methods Fifty-five specific-pathogen-free male Sprague-Dawley rats were randomly divided into blank(n=30),anduolin(n=10),and YQJD groups(n=15).They were respectively gavaged with deionized water,anduolin suspension(0.345 6 g/kg),and YQJD high-dose(20.88 g/kg)at a dose of 0.01 mL/g body weight once a day for seven consecutive days.2 hours after the last gavage,blood was collected from the abdominal aorta to prepare the control rat,andolin rat,and YQJD high-dose sera.Appropriate amounts of YQJD high-dose and control sera were mixed in a ratio of 1∶1 and 1∶3,respectively,to obtain YQJD medium-and low-dose rat serum.RAW264.7 cells were divided into blank(10%blank rat serum),model(10%blank rat serum),anduolin(10%anduolin rat serum),and YQJD-L,YQJD-M,YQJD-H groups(10%YQJD low-,medium-,and high-dose rat serum).Except for the blank group,the cells in other groups were irradiated with 12 Gy60 Co γ-rays once to establish the macrophage radiation injury model.At 24 h after irradiation,cell viability was detected using the CCK-8 method,and the cell migration rate was measured using the scratch test.Cell morphology was observed using phalloidin staining,tumor necrosis factor-alpha(TNF-α)and interleukin-10(IL-10)levels in the cell supernatant were quantified using enzyme-linked immunosorbent assay,and the proportion of M1 macrophages was detected using flow cytometry.TLR4,MyD88,and NF-κB protein expression were detected using Western blotting.Results Twenty-four hours after irradiation,compared with the blank group,the model group exhibited significantly reduced cell viability and migration rate(P<0.01),increased cell volume and pseudopodia formation,elevated TNF-α and IL-10 levels,an increased proportion of M1 macrophages,and upregulated TLR4,MyD88,and NF-κB protein expression(P<0.05,P<0.01).Compared with the model group,each drug-treated group showed improved cell viability and migration rate(P<0.05,P<0.01),decreased cell volume,more regular cell shape,reduced TNF-α levels,lower M1-type macrophage proportion,and downregulated TLR4,MyD88,and NF-κB protein expression(P<0.05,P<0.01).IL-10 level showed an upward trend.Conclusion YQJD can partially inhibit M1 macrophage polarization and suppress inflammatory responses,which may be related to the TLR4/MyD88/NF-κB signaling pathway.

Background:Acute pancreatitis(AP)is a common disease of the digestive system,among which severe acute pancreatitis(SAP)has a high mortality rate.Finding more accurate and convenient methods for early recognition of SAP is one of the major challenges in clinical treatment.Aims:To explore the application value of the controlled attenuation parameter(CAP)of ultrasound elastography in predicting SAP.Methods:A retrospective cohort study was conducted involving 135 AP patients admitted to Jiading Branch of Shanghai General Hospital from February to October 2024.Patients were categorized into non-SAP and SAP groups according to the severity of the disease.Clinical data,local complications,laboratory indicators,and CAP were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for SAP.A SAP prediction model based on CAP was constructed according to the identified risk factors and the minimum Akaike information criterion(AIC).ROC curve and Bootstrap method were used to evaluate the efficacy of the prediction model and conduct internal validation,respectively.Results:There were statistically significant differences between the non-SAP group and SAP group in body mass index(BMI),incidence of hyperlipidemia,etiological composition,incidence of pleural and ascitic fluid,length of hospital stay,incidence of peripancreatic effusion,incidence of pancreatic necrosis,white blood cell count(WBC),D-dimer(D-D)level,blood glucose,triglyceride(TG),C-reactive protein(CRP),neutrophil count,procalcitonin(PCT),interleukin-6(IL-6),free triiodothyronine(FT3),and CAP(all P<0.05).Multivariate Logistic regression analysis showed that pancreatic necrosis(OR=13.39,95%CI:3.10-57.94,P<0.001)and CAP(OR=1.01,95%CI:1.01-1.02,P=0.038)were independent risk factors for SAP.The SAP prediction model based on CAP was formulated as:Logit(P)=-5.884+0.010×CAP+2.839×pancreatic necrosis+0.169×D-D+0.132×blood glucose+0.006×CRP.The model showed an area under the curve(AUC)of 0.834 for predicting SAP,which was superior to CAP alone(P<0.05).Internal validation indicated that the prediction model had high stability and accuracy(C-index=0.808).Conclusions:The prediction model constructed based on CAP has good clinical value for predicting SAP,providing a new perspective and tool for early identification and prognostic assessment of AP.

Background:Acute pancreatitis(AP)is a common disease of the digestive system,among which severe acute pancreatitis(SAP)has a high mortality rate.Finding more accurate and convenient methods for early recognition of SAP is one of the major challenges in clinical treatment.Aims:To explore the application value of the controlled attenuation parameter(CAP)of ultrasound elastography in predicting SAP.Methods:A retrospective cohort study was conducted involving 135 AP patients admitted to Jiading Branch of Shanghai General Hospital from February to October 2024.Patients were categorized into non-SAP and SAP groups according to the severity of the disease.Clinical data,local complications,laboratory indicators,and CAP were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for SAP.A SAP prediction model based on CAP was constructed according to the identified risk factors and the minimum Akaike information criterion(AIC).ROC curve and Bootstrap method were used to evaluate the efficacy of the prediction model and conduct internal validation,respectively.Results:There were statistically significant differences between the non-SAP group and SAP group in body mass index(BMI),incidence of hyperlipidemia,etiological composition,incidence of pleural and ascitic fluid,length of hospital stay,incidence of peripancreatic effusion,incidence of pancreatic necrosis,white blood cell count(WBC),D-dimer(D-D)level,blood glucose,triglyceride(TG),C-reactive protein(CRP),neutrophil count,procalcitonin(PCT),interleukin-6(IL-6),free triiodothyronine(FT3),and CAP(all P<0.05).Multivariate Logistic regression analysis showed that pancreatic necrosis(OR=13.39,95%CI:3.10-57.94,P<0.001)and CAP(OR=1.01,95%CI:1.01-1.02,P=0.038)were independent risk factors for SAP.The SAP prediction model based on CAP was formulated as:Logit(P)=-5.884+0.010×CAP+2.839×pancreatic necrosis+0.169×D-D+0.132×blood glucose+0.006×CRP.The model showed an area under the curve(AUC)of 0.834 for predicting SAP,which was superior to CAP alone(P<0.05).Internal validation indicated that the prediction model had high stability and accuracy(C-index=0.808).Conclusions:The prediction model constructed based on CAP has good clinical value for predicting SAP,providing a new perspective and tool for early identification and prognostic assessment of AP.

Objective To investigate the regulatory effect and mechanism of Yiqi Jiedu Decoction(YQJD)on ionizing radiation-induced macrophage polarization and its correlation with the Toll-like receptor 4(TLR4)/myeloid differentiation primary response protein 88(MyD88)/nuclear factor kappa-B(NF-κB)signaling pathway.Methods Fifty-five specific-pathogen-free male Sprague-Dawley rats were randomly divided into blank(n=30),anduolin(n=10),and YQJD groups(n=15).They were respectively gavaged with deionized water,anduolin suspension(0.345 6 g/kg),and YQJD high-dose(20.88 g/kg)at a dose of 0.01 mL/g body weight once a day for seven consecutive days.2 hours after the last gavage,blood was collected from the abdominal aorta to prepare the control rat,andolin rat,and YQJD high-dose sera.Appropriate amounts of YQJD high-dose and control sera were mixed in a ratio of 1∶1 and 1∶3,respectively,to obtain YQJD medium-and low-dose rat serum.RAW264.7 cells were divided into blank(10%blank rat serum),model(10%blank rat serum),anduolin(10%anduolin rat serum),and YQJD-L,YQJD-M,YQJD-H groups(10%YQJD low-,medium-,and high-dose rat serum).Except for the blank group,the cells in other groups were irradiated with 12 Gy60 Co γ-rays once to establish the macrophage radiation injury model.At 24 h after irradiation,cell viability was detected using the CCK-8 method,and the cell migration rate was measured using the scratch test.Cell morphology was observed using phalloidin staining,tumor necrosis factor-alpha(TNF-α)and interleukin-10(IL-10)levels in the cell supernatant were quantified using enzyme-linked immunosorbent assay,and the proportion of M1 macrophages was detected using flow cytometry.TLR4,MyD88,and NF-κB protein expression were detected using Western blotting.Results Twenty-four hours after irradiation,compared with the blank group,the model group exhibited significantly reduced cell viability and migration rate(P<0.01),increased cell volume and pseudopodia formation,elevated TNF-α and IL-10 levels,an increased proportion of M1 macrophages,and upregulated TLR4,MyD88,and NF-κB protein expression(P<0.05,P<0.01).Compared with the model group,each drug-treated group showed improved cell viability and migration rate(P<0.05,P<0.01),decreased cell volume,more regular cell shape,reduced TNF-α levels,lower M1-type macrophage proportion,and downregulated TLR4,MyD88,and NF-κB protein expression(P<0.05,P<0.01).IL-10 level showed an upward trend.Conclusion YQJD can partially inhibit M1 macrophage polarization and suppress inflammatory responses,which may be related to the TLR4/MyD88/NF-κB signaling pathway.

Objective:To evaluate the application of metagenomic next-generation sequencing (mNGS) in the diagnosis of osteoarticular infection.Methods:The clinical data of 37 inpatients aged 32-90 year with osteoarticular infection admitted in the Department of Spine Surgery of Qingdao Chest Hospital from January to December 2019 were retrospectively analyzed. There were 31 cases of spine infection and 6 cases of other joint infection. The tissue samples were obtained from the infected sites through puncture or surgical approach in all patients. The tissue samples were subjected to routine culture of mycobacteria, aerobic bacteria and anaerobic bacteria, respectively. The gene amplification and mNGS were performed for detection of mycobacterium tuberculosis DNA (MTB-DNA). The chi-square test or Fisher’s exact test were used to compare the detection rates of pathogen and simple bacterial infection between mNGS and conventional culture. The conventional culture, mNGS and MTB-DNA amplification detection were performed for all samples; with clinical diagnosis as the gold standard, the diagnostic values of 3 methods were evaluated with receiver operating characteristic curve (ROC). Paired sample t test was used to compare white blood cell(WBC) count, erythrocyte sedimentation rate, C-reactive protein of patients before and after treatment. P<0.05 was considered statistically significant. Results:The pathogens were detected by mNGS for 42 times: bacteria for 39 times (92.8%), fungi for twice (4.8%) and Kirks body for once (2.4%). Among 37 patients there were 29 cases of pure bacterial infection (78.4%), 2 cases of pure fungi infection (5.4%), 1 case of pure Kirks body infection (2.7%), and 5 cases of mixed infection of two or more pathogens (13.5%). The detection rates of mNGS and conventional culture were 100.0% (37/37) and 67.6% (25/37), respectively ( χ2=13.987, P<0.05). The detection rates of mNGS and conventional culture in 29 patients with pure bacterial infection were 100.0% (29/29) and 69.0% (20/29), respectively ( χ2=16.913, P<0.05). The area under the ROC curve (AUC) of conventional culture, mNGS, and MTB-DNA in the diagnosis of osteoarticular tuberculosis infection was 0.958 (95% CI: 0.866-1.000, P<0.05), 1.000 (95% CI: 1.000-1.000, P<0.05) and 0.958 (95% CI: 0.866-1.000, P<0.05). All the 37 patients were treated with anti-infective drugs according to the results of mNGS and conventional culture. Among them, 28 patients received surgical intervention. The patients were followed up until April 30, 2020, 1 patient died. After 3 months of follow-up, the WBC count, erythrocyte sedimentation rate and C-reactive protein were (5.5±1.5)×10 9/L, (41±38)mm/h and (5.0±4.6) mg/L, respectively, which were lower than those before anti-infection treatment [(8.0±2.9)×10 9/L, (79±42)mm/h and(63±52)mg/L] ( t=6.536, 8.302 and 6.373, all P<0.05). Conclusion:The metagenomic next-generation sequencing may have important clinical value in the differential diagnosis of osteoarticular infection.

Objective    To compare short- and medium-term effects of Leonardo da Vinci robot-assisted and traditional mitral valvuloplasty. Methods    We conducted a retrospective analysis of 74 patients who underwent mitral valvuloplasty in our hospital from January 2015 to March 2017. The patients were divided into two groups according to the mode of operation: a da Vinci group (n=29, 13 males, 16 females at an average age of 52 years) and a routine group (n=45, 18 males, 27 females at an average age of 53 years). The perioperative data of patients in the two groups were compared and analyzed. Results    There was no significant difference in sex, age, weight, height, body mass index (BMI), cardiac function (NYHA), hypertension, diabetes, postoperative blood transfusion and postoperative complications between the two groups (P>0.05). The tracheal intubation time, ICU retention time, hospital stay time, blood loss and postoperative drainage in the da Vinci group were shorter or less than those in the routine group (P<0.05). The operation time, cardiopulmonary bypass time and aortic clamping time in the da Vinci group were longer than those in the routine group (P<0.05). Different surgical procedures had no significant effect on left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) 3 years after operation. There was no interaction between the mode of operation and the time of follow-up. There was no significant difference in echocardiographic evaluation in the same period (P>0.05). Conclusion    Da Vinci operation shortens the rehabilitation process of patients compared with traditional surgery. For short- and medium-term follow-up results, there is no difference between Leonardo da Vinci and traditional mitral valve surgeries, and the clinical effect of da Vinci robot-assisted mitral valvuloplasty is satisfactory, which is worthy of further clinical promotion.