Based on the theory of the liver's"using bitter herbs to nourish or purge"from Huangdi Neijing,this paper systematically elucidates the theoretical foundation for treating functional constipation from liver.Focusing on the physiological characteristic of"liver desires to disperse"and the pathological manifestation of"liver bitterness and urgency,"combined with the"liver communicates with the large intestine"theory,this paper establishes a diagnostic and therapeutic framework for managing functional constipation by regulating liver function.The pathological evolution of functional constipation manifests in three distinct stages:in the early stage,liver qi stagnation leads to large intestine qi obstruction,where damaged by an excess of seven emotions resulting in symptoms such as difficult defecation,abdominal bloating,and hypochondriac pain;in the middle stage,liver depression transforms into fire,scorching bodily fluids to generate dryness,thereby creating a pathological interplay of stagnation,fire,and dryness,which is marked by anal heat,dry mouth,and yellow urine;in the late stage,yin deficiency in liver and kidney causes large intestine malnutrition,resulting in a complex pathological state where yin deficiency,collateral blockage,dryness accumulation,and blood stasis intertwine,clinically manifesting as pellet-like stools(resembling sheep feces)and soreness and weakness of the waist and knees.In treatment,the formula design follows the principle of"sweetness to relieve,acridity to tonify,and sourness to purge,"with treatment principles varying across stages.In the early stage,the focus is on dispersing liver and regulating qi,and unblocking the zang-fu viscera;in the middle stage,the priority shifts to clearing heat-fire,nourishing large intestine,and promoting fluid production;whereas,in the late stage,the emphasis lies on nourishing yin,unblocking collaterals,and promoting blood circulation.This staged treatment of functional constipation overcomes the limitations of solely focusing on nourishing large intestine and facilitating feces excretion,thereby advancing the treatment of different stages based on syndrome differentiation and personalized treatment.It provides theoretical support for improving patients' intestinal function and enhancing overall health outcomes.

Based on the theory of the liver's"using bitter herbs to nourish or purge"from Huangdi Neijing,this paper systematically elucidates the theoretical foundation for treating functional constipation from liver.Focusing on the physiological characteristic of"liver desires to disperse"and the pathological manifestation of"liver bitterness and urgency,"combined with the"liver communicates with the large intestine"theory,this paper establishes a diagnostic and therapeutic framework for managing functional constipation by regulating liver function.The pathological evolution of functional constipation manifests in three distinct stages:in the early stage,liver qi stagnation leads to large intestine qi obstruction,where damaged by an excess of seven emotions resulting in symptoms such as difficult defecation,abdominal bloating,and hypochondriac pain;in the middle stage,liver depression transforms into fire,scorching bodily fluids to generate dryness,thereby creating a pathological interplay of stagnation,fire,and dryness,which is marked by anal heat,dry mouth,and yellow urine;in the late stage,yin deficiency in liver and kidney causes large intestine malnutrition,resulting in a complex pathological state where yin deficiency,collateral blockage,dryness accumulation,and blood stasis intertwine,clinically manifesting as pellet-like stools(resembling sheep feces)and soreness and weakness of the waist and knees.In treatment,the formula design follows the principle of"sweetness to relieve,acridity to tonify,and sourness to purge,"with treatment principles varying across stages.In the early stage,the focus is on dispersing liver and regulating qi,and unblocking the zang-fu viscera;in the middle stage,the priority shifts to clearing heat-fire,nourishing large intestine,and promoting fluid production;whereas,in the late stage,the emphasis lies on nourishing yin,unblocking collaterals,and promoting blood circulation.This staged treatment of functional constipation overcomes the limitations of solely focusing on nourishing large intestine and facilitating feces excretion,thereby advancing the treatment of different stages based on syndrome differentiation and personalized treatment.It provides theoretical support for improving patients' intestinal function and enhancing overall health outcomes.

Objective To investigate the prognosis of patients with triple-negative invasive lobular carcinoma (TN-ILC) undergoing breast-conserving surgery combined with radiotherapy (BCS+RT) versus total mastectomy. Methods A retrospective analysis was performed for 2 386 female patients with TN-ILC who underwent surgery in the SEER database from 2006 to 2018, and the baseline characteristics (age, histological grade, AJCC stage, etc.) were balanced by propensity score matching (PSM, 1∶1, caliper value 0.02), and breast cancer-specific survival (BCSS) and overall survival (OS) were compared by Kaplan-Meier method and COX regression analysis. Results A total of 1 056 pairs of patients were obtained after PSM, and the BCS+RT group had significantly better BCSS and OS than the total mastectomy group (both P<0.001). Stratified analyses showed that BCS+RT had a survival advantage in all subgroups except histologic grade Ⅰ and tumor stage Ⅰ. Multivariate analysis confirmed that BCS+RT was an independent protective factor (BCSS: HR=0.682, OS: HR=0.607, both P<0.001). Conclusions BCS+RT significantly improves survival compared with total mastectomy in patients with TN-ILC, supporting BCS+RT as the preferred treatment strategy for eligible patients.

Objective:To determine the correlation between serum soluble CD146 (sCD146) levels and disease activity in patients with systemic vasculitis and the potential of sCD146 as a novel biomarker.Methods:We recruited 304 patients from the systemic vasculitis cohort at Peking Union Medical College Hospital from July 2013 to December 2022. The cohort comprised 200 patients with Takayasu arteritis (TAK) and 104 with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The patient′s demographic and clinical data, including age, sex, disease duration, disease type, laboratory results, and disease status, were extracted from the database. The serum sCD146 concentration was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Continuous variables were presented as mean±standard deviation if normally distributed, with between-group comparisons conducted using the t-test. For non-normally distributed data, median ( Q1, Q3) was used, and comparisons between groups were performed using the Mann-Whitney U test. Categorical data were expressed as percentages, and comparisons between groups were conducted using the Chi-square test or Fisher′s exact test,as appropriate. Kendall′s tau-b′s rank correlation coefficient was calculated to evaluate the correlation between sCD146 and variables associated with systemic vasculitis. A two-sided P value <0.05 was considered statistically significant. Results:Serum sCD146 levels were significantly lower in patients with active disease compared to those in remission in both cohorts [TAK: 246 (218, 287) vs. 277 (230, 322) μg/L, Z=-2.58, P=0.010; AAV: (301±90) vs. (344±81) μg/L, t=-2.56, P=0.007]. Serum sCD146 levels were positively correlated with age and disease duration (TAK: τ=0.09, 0.12, P=0.040, P=0.009; AAV: τ=0.28, 0.15, P<0.001, P=0.020). In patients with TAK, sCD146 levels were negatively correlated with IL-6, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and disease activity status ( τ=-0.17, -0.18, -0.16, -0.16; P=0.001, P<0.001, P=0.003, P=0.010). In patients with AAV, sCD146 levels were negatively correlated with platelet count (PLT),disease activity status,and the Birmingham Vasculitis Activity Score ( τ=-0.36, -0.27, -0.27; P<0.001, P=0.007, P=0.001). Conclusion:Serum sCD146 levels were significantly lower in patients with active systemic vasculitis than in remission, displaying a negative correlation with disease activity. These findings suggest that sCD146 has potential as a novel biomarker for assessing disease activity in systemic vasculitis.

Objective To evaluate the clinical efficacy of modified Yulinzhu Formula combined with plum-blossom needle tapping acupuncture in treating kidney-yang deficiency type of ovulatory dysfunction infertility(ODI).Methods A total of 100 ODI patients diagnosed at Hengshui Hospital of Traditional Chinese Medicine between January 2023 and January 2024 were enrolled and randomly divided into an observation group and a control group using a random number table,with 50 cases in each group.The control group received conventional western medical treatment,while the observation group received additional oral administration of modified Yulinzhu Formula and plum-blossom needle tapping acupuncture therapy.Treatment was administered for one menstrual cycle as a course,with three consecutive courses completed.After three months,clinical efficacy was assessed by comparing traditional Chinese medicine(TCM)syndrome scores,ovulation rate,pregnancy rate,proportion of type A endometrium,ovarian volume,antral follicle count(AFC),and adverse reactions between groups.Results(1)After treatment,the scores of TCM syndromes in the two groups were significantly improved(P＜0.05),and the improvement in the observation group was superior to that in the control group,the difference being significant(P＜0.05).(2)The total effective rate was 90.00％(45/50)in the observation group and 72.00％(36/50)in the control group.The curative effect of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(3)The ovulation rate,pregnancy rate and the proportion of type A endometrium in the observation group were significantly superior to those in the control group,and the differences were statistically significant(P＜0.05).(4)After treatment,the ovarian volume and the number of antral follicles in the two groups were significantly improved(P＜0.05),and the improvement in the ovarian volume and the number of antral follicles in the observation group was superior to that in the control group,the difference being significant(P＜0.05).(5)The incidence of adverse reactions was 8.00％(4/50)in the observation group and 24.00％(12/50)in the control group.The incidence of adverse reactions in the observation group was significantly lower than that in the control group,the difference was statistically significant(P＜0.05).Conclusion Modified Yulinzhu Formula combined with plum-blossom needle tapping acupuncture effectively improves clinical symptoms,enhances ovulation/pregnancy rates,increases type A endometrium,optimizes ovarian volume and AFC,and reduces adverse reactions in kidney-yang deficiency ODI patients.

Objective: To investigate the correlation between peripheral blood CD4 T lymphocyte subsets and delayed graft function (DGF) and short-term prognosis in kidney transplant recipients, so as to help optimize preoperative assessment for kidney transplantation and provide insights into the immune mechanisms of DGF. Methods: A retrospective analysis was conducted on the clinical data of 103 kidney transplant recipients at the First Affiliated Hospital of Soochow University during Jun.2022 and Oct.2023. A total of 61 recipients were finally included in this study, and were categorized into two groups based on postoperative renal function recovery：the DGF group (n=20) and the immediate graft function (IGF) group (n=41).Flow cytometry was used to detect the proportions and absolute counts of various CD4 T lymphocyte subsets in the peripheral blood on postoperative day 7.The clinical data and peripheral blood lymphocyte subsets between the two groups were compared.For the subsets that exhibited significant differences, the correlation between their proportions and absolute counts and serum creatinine (Scr) levels on postoperative day 7 was further analyzed in the DGF group.Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to evaluate the predictive performance of the most strongly correlated CD4 T lymphocyte subset in terms of proportion and absolute count for short-term renal function. Results: There were no statistically significant differences in the proportions and absolute counts of Th1, Th2, Th17, and regulatory T cells (Treg) between the DGF and IGF groups (P>0.05).The proportions and absolute counts of follicular helper T cells (Tfh) and PD-1 Tfh cells were significantly higher in the DGF group than in the IGF group (P＜0.000 1). The Scr levels at 1 month and 1 year postoperatively were significantly higher in the DGF group than in the IGF group (P＜0.01), while the estimated glomerular filtration rate (eGFR) was significantly lower in the DGF group compared with the IGF group (P＜0.01, P=0.02).Spearman correlation analysis showed that the proportions and absolute counts of Tfh and PD-1 Tfh cell subsets were positively correlated with the Scr level on post-operative day 7 in the DGF group (P＜0.05).The ROC curve demonstrated that the AUC for the proportion of PD-1 Tfh cells in predicting Scr and eGFR at 1 month after surgery was 0.73(95%CI:0.61-0.86) and 0.75 (95%CI:0.62-0.88), respectively.Additionally, the AUC for predicting Scr and eGFR at 1 year was 0.72(95%CI:0.59-0.86) and 0.70(95%CI:0.58-0.83), respectively. Conclusion: The increase in the proportions and absolute counts of Tfh and PD-1 Tfh cells is associated with postoperative DGF of renal transplant recipients, and the proportion of PD-1 Tfh cells may help predict the short-term renal function of recipients.

Objective:To determine the correlation between serum soluble CD146 (sCD146) levels and disease activity in patients with systemic vasculitis and the potential of sCD146 as a novel biomarker.Methods:We recruited 304 patients from the systemic vasculitis cohort at Peking Union Medical College Hospital from July 2013 to December 2022. The cohort comprised 200 patients with Takayasu arteritis (TAK) and 104 with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The patient′s demographic and clinical data, including age, sex, disease duration, disease type, laboratory results, and disease status, were extracted from the database. The serum sCD146 concentration was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Continuous variables were presented as mean±standard deviation if normally distributed, with between-group comparisons conducted using the t-test. For non-normally distributed data, median ( Q1, Q3) was used, and comparisons between groups were performed using the Mann-Whitney U test. Categorical data were expressed as percentages, and comparisons between groups were conducted using the Chi-square test or Fisher′s exact test,as appropriate. Kendall′s tau-b′s rank correlation coefficient was calculated to evaluate the correlation between sCD146 and variables associated with systemic vasculitis. A two-sided P value <0.05 was considered statistically significant. Results:Serum sCD146 levels were significantly lower in patients with active disease compared to those in remission in both cohorts [TAK: 246 (218, 287) vs. 277 (230, 322) μg/L, Z=-2.58, P=0.010; AAV: (301±90) vs. (344±81) μg/L, t=-2.56, P=0.007]. Serum sCD146 levels were positively correlated with age and disease duration (TAK: τ=0.09, 0.12, P=0.040, P=0.009; AAV: τ=0.28, 0.15, P<0.001, P=0.020). In patients with TAK, sCD146 levels were negatively correlated with IL-6, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and disease activity status ( τ=-0.17, -0.18, -0.16, -0.16; P=0.001, P<0.001, P=0.003, P=0.010). In patients with AAV, sCD146 levels were negatively correlated with platelet count (PLT),disease activity status,and the Birmingham Vasculitis Activity Score ( τ=-0.36, -0.27, -0.27; P<0.001, P=0.007, P=0.001). Conclusion:Serum sCD146 levels were significantly lower in patients with active systemic vasculitis than in remission, displaying a negative correlation with disease activity. These findings suggest that sCD146 has potential as a novel biomarker for assessing disease activity in systemic vasculitis.

Objective To investigate and analyze the impact of three personalized surgical design schemes for SPT trans PRK on postoperative visual quality and higher-order aberrations in individuals with myopic astigma-tism,aiming to provide a foundation for more rational selection of personalized design schemes.Methods The 96 cases(96 eyes)with myopic astigmatism were divided into three groups based on three personalized design schemes and a conventional mode.Specifically,24 eyes were assigned to the personalized group 1,which focused on coma elimination;another 24 eyes belonged to personalized group 2,where the aim was to minimize spherical aberration elimination;and the remaining 24 eyes were further categorized into personalized group 3 based on a model that aimed at minimizing spherical aberration.Additionally,there were also 24 eyes in the control group treated using the conventional mode.The study compared and analyzed various parameters including best corrected visual acuity,spherical aberration,coma,total higher-order aberration of the anterior corneal surface,as well as differences in corneal ablation thickness between personalized and conventional schemes within the surgical design software.Results(1)The postoperative visual acuity of the personalized group was significantly superior to that of the control group(P＜0.05);(2)Among the personalized groups,Group 2 exhibited a reduced amount of cor-neal tissue ablation compared to other groups(P＜0.01);(3)Group 2 demonstrated lower values than the other groups after surgery(P＜0.05).(4)Coma:The control group showed a significantly higher level of coma com-pared to preoperative measurements(P＜0.01).No significant differences were observed between Groups 1,2,and 3 after surgery(P＞0.05).(5)Total higher-order aberrations:All groups experienced a significant increase in total higher-order aberrations following surgery(P＜0.01).Group 2 exhibited lower values than the other groups postoperatively(P＜0.05).Conclusion For myopic astigmatism,SPT trans PRK incorporates the personalized surgical scheme with a focus on minimizing spherical aberration elimination mode,resulting in enhanced optimiza-tion of postoperative high-order aberration and improved visual quality,while preserving corneal tissue.

Objective To investigate and analyze the impact of three personalized surgical design schemes for SPT trans PRK on postoperative visual quality and higher-order aberrations in individuals with myopic astigma-tism,aiming to provide a foundation for more rational selection of personalized design schemes.Methods The 96 cases(96 eyes)with myopic astigmatism were divided into three groups based on three personalized design schemes and a conventional mode.Specifically,24 eyes were assigned to the personalized group 1,which focused on coma elimination;another 24 eyes belonged to personalized group 2,where the aim was to minimize spherical aberration elimination;and the remaining 24 eyes were further categorized into personalized group 3 based on a model that aimed at minimizing spherical aberration.Additionally,there were also 24 eyes in the control group treated using the conventional mode.The study compared and analyzed various parameters including best corrected visual acuity,spherical aberration,coma,total higher-order aberration of the anterior corneal surface,as well as differences in corneal ablation thickness between personalized and conventional schemes within the surgical design software.Results(1)The postoperative visual acuity of the personalized group was significantly superior to that of the control group(P＜0.05);(2)Among the personalized groups,Group 2 exhibited a reduced amount of cor-neal tissue ablation compared to other groups(P＜0.01);(3)Group 2 demonstrated lower values than the other groups after surgery(P＜0.05).(4)Coma:The control group showed a significantly higher level of coma com-pared to preoperative measurements(P＜0.01).No significant differences were observed between Groups 1,2,and 3 after surgery(P＞0.05).(5)Total higher-order aberrations:All groups experienced a significant increase in total higher-order aberrations following surgery(P＜0.01).Group 2 exhibited lower values than the other groups postoperatively(P＜0.05).Conclusion For myopic astigmatism,SPT trans PRK incorporates the personalized surgical scheme with a focus on minimizing spherical aberration elimination mode,resulting in enhanced optimiza-tion of postoperative high-order aberration and improved visual quality,while preserving corneal tissue.