Pancreatic cancer （PC）， a highly malignant tumor of the digestive system， is characterized by extremely high incidence and mortality rates， imposing a severe burden on the healthcare system. Despite significant advancements in comprehensive therapeutic strategies for PC， clinical benefits for patients remain limited due to the high heterogeneity and unique microenvironment of the tumor. Therefore， further elucidating the molecular mechanisms underlying PC progression and developing novel， effective therapeutic strategies have become an urgent necessity in the current research. Programmed cell death （PCD） is a genetically orchestrated process of autonomous cell demise that is crucial for maintaining cellular homeostasis. Recent studies have demonstrated that tumor cells can remodel the tumor microenvironment by modulating various PCD pathways—including apoptosis， autophagy， pyroptosis， and ferroptosis—thereby driving tumor proliferation， invasion， and drug resistance. Traditional Chinese medicine （TCM） possesses unique advantages in anti-tumor therapy， characterized by multi-component， multi-target， and multi-pathway regulation. Accumulating evidence suggests that TCM formulas and their natural active compounds can effectively delay the malignant progression of PC by modulating PCD in tumor cells. This article systematically summarizes the molecular mechanisms of PCD in PC progression and reviews the mechanisms by which TCM formulas and natural active compounds intervene in PC through PCD modulation. This review aims to provide theoretical support and future research directions for the prevention and treatment of PC with TCM.

AIM:To investigate the effect of Jianpi-Huayu decoction(JPHYD)combined with gemcitabine(GEM)on ferroptosis of pancreatic cancer PANC-1 cells and its mechanism.METHODS:PANC-1 cells were cultured in vitro,and CCK8 method was used to detect the cell viability after different concentrations of JPHYD and GEM,and ap-propriate concentrations were selected for follow-up experiments.EDU assay and clonogenesis assay were used to detect cell proliferation.The apoptosis rate was detected by flow cytometry.Intracellular reactive oxygen species(ROS)were de-tected by DCFH-DA fluorescent probe and lipid peroxidation was detected by BODIPY 581/591C11 staining.The contents of glutathione(GSH),ferrous ion(Fe2+)and malondialdehyde(MDA)in the cells were detected by the kit.The mRNA levels and protein expression levels of Nrf2,HO-1,SLC7A11,GPX4,TFR1 and ACSL4 were detected by RT-qPCR and Western blot.RESULTS:Compared with the control group,the cell viability of PANC-1 treated with JPHYD and GEM was significantly decreased in a concentration-dependent manner.And the combined use of the two can significantly im-prove the cytotoxic effect of GEM and have a synergistic effect;Compared with control group,JPHYD group,GEM group and JPHYD+GEM group can significantly reduce EDU positive efficiency,colony formation numbers and promote cell apoptosis,and the combined group has the most obvious effect.After adding JPHYD+GEM into the cells,the cells be-came rounded and the cell viability decreased.The addition of ferrostatin-1(Fer-1),an inhibitor of ferroptosis,had no significant effect on cell morphology and viability,and the co-treatment with JPHYD+GEM and Fer-1 could reverse the ef-fects of JPHYD+GEM on cell morphology and viability.Compared with control group and GEM group,JPHYD+GEM group can significantly increase the levels of intracellular reactive oxygen species(ROS)and lipid peroxidation,increase the levels of Fe2+and MDA,decrease the levels of GSH,further promote lipid peroxidation and induce ferroptosis.JPHYD+GEM also significantly down-regulated the mRNA and protein expressions of Nrf2,HO-1,SLC7A11 and GPX4,and up-regulated the mRNA and protein expressions of TFR1 and ACSL4.The addition of Fer-1 significantly reversed the activation of iron death in the combined treatment group and reversed its efficacy,and the difference was statistically signif-icant.CONCLUSION:Jianpi Huayu decoction and gemcitabine may induce ferroptosis of PANC-1 cells by inhibiting Nrf2/SLC7A11/GPX4 axis in vitro,thus playing a synergistic anticancer role.

AIM:To investigate the effect of Jianpi-Huayu decoction(JPHYD)combined with gemcitabine(GEM)on ferroptosis of pancreatic cancer PANC-1 cells and its mechanism.METHODS:PANC-1 cells were cultured in vitro,and CCK8 method was used to detect the cell viability after different concentrations of JPHYD and GEM,and ap-propriate concentrations were selected for follow-up experiments.EDU assay and clonogenesis assay were used to detect cell proliferation.The apoptosis rate was detected by flow cytometry.Intracellular reactive oxygen species(ROS)were de-tected by DCFH-DA fluorescent probe and lipid peroxidation was detected by BODIPY 581/591C11 staining.The contents of glutathione(GSH),ferrous ion(Fe2+)and malondialdehyde(MDA)in the cells were detected by the kit.The mRNA levels and protein expression levels of Nrf2,HO-1,SLC7A11,GPX4,TFR1 and ACSL4 were detected by RT-qPCR and Western blot.RESULTS:Compared with the control group,the cell viability of PANC-1 treated with JPHYD and GEM was significantly decreased in a concentration-dependent manner.And the combined use of the two can significantly im-prove the cytotoxic effect of GEM and have a synergistic effect;Compared with control group,JPHYD group,GEM group and JPHYD+GEM group can significantly reduce EDU positive efficiency,colony formation numbers and promote cell apoptosis,and the combined group has the most obvious effect.After adding JPHYD+GEM into the cells,the cells be-came rounded and the cell viability decreased.The addition of ferrostatin-1(Fer-1),an inhibitor of ferroptosis,had no significant effect on cell morphology and viability,and the co-treatment with JPHYD+GEM and Fer-1 could reverse the ef-fects of JPHYD+GEM on cell morphology and viability.Compared with control group and GEM group,JPHYD+GEM group can significantly increase the levels of intracellular reactive oxygen species(ROS)and lipid peroxidation,increase the levels of Fe2+and MDA,decrease the levels of GSH,further promote lipid peroxidation and induce ferroptosis.JPHYD+GEM also significantly down-regulated the mRNA and protein expressions of Nrf2,HO-1,SLC7A11 and GPX4,and up-regulated the mRNA and protein expressions of TFR1 and ACSL4.The addition of Fer-1 significantly reversed the activation of iron death in the combined treatment group and reversed its efficacy,and the difference was statistically signif-icant.CONCLUSION:Jianpi Huayu decoction and gemcitabine may induce ferroptosis of PANC-1 cells by inhibiting Nrf2/SLC7A11/GPX4 axis in vitro,thus playing a synergistic anticancer role.

OBJECTIVETo evaluate the diagnostic efficacy of IFIR-FIESTA technique in detecting renal artery stenosis in elderly patients.

METHODSTwenty-seven aged patients underwent both IFIR-FIESTA and 3D CE-MRA examinations. The imaging quality and renal artery stenosis grades were evaluated. Kappa test was used to assess the consistency between the two methods. With CE-MRA as the reference, the diagnostic sensitivity, specificity, accuracy, PPV and NPV for IFIR-FIESTA were calculated in detecting renal artery stenosis.

RESULTSThe images by the two methods were 100% qualified for diagnosis, although the image quality of CE-MRA was significantly better. IFIR-FIESTA and CE-MRA showed excellent consistency in detecting renal artery stenosis. With CE-MRA as the reference, the diagnostic sensitivity, specificity, accuracy, PPV and NPV for IFIR-FIESTA were 97.1%, 100%, 98.1%, 100%, and 95% in detecting renal artery stenosis, respectively.

CONCLUSIONIFIR-FIESTA is feasible as a routine examination for detecting renal artery stenosis in elderly patients.

Aged ; Aged, 80 and over ; Contrast Media ; Feasibility Studies ; Female ; Humans ; Magnetic Resonance Angiography ; methods ; Male ; Middle Aged ; Renal Artery Obstruction ; diagnosis ; Sensitivity and Specificity

Objective To evaluate the diagnostic efficacy of IFIR-FIESTA technique in detecting renal artery stenosis in elderly patients. Methods Twenty-seven aged patients underwent both IFIR-FIESTA and 3D CE-MRA examinations. The imaging quality and renal artery stenosis grades were evaluated. Kappa test was used to assess the consistency between the two methods. With CE-MRA as the reference, the diagnostic sensitivity, specificity, accuracy, PPV and NPV for IFIR-FIESTA were calculated in detecting renal artery stenosis. Results The images by the two methods were 100% qualified for diagnosis, although the image quality of CE-MRA was significantly better. IFIR-FIESTA and CE-MRA showed excellent consistency in detecting renal artery stenosis. With CE-MRA as the reference, the diagnostic sensitivity, specificity, accuracy, PPV and NPV for IFIR-FIESTA were 97.1%, 100%, 98.1%, 100%, and 95%in detecting renal artery stenosis, respectively. Conclusion IFIR-FIESTA is feasible as a routine examination for detecting renal artery stenosis in elderly patients.

Objective To evaluate the diagnostic efficacy of IFIR-FIESTA technique in detecting renal artery stenosis in elderly patients. Methods Twenty-seven aged patients underwent both IFIR-FIESTA and 3D CE-MRA examinations. The imaging quality and renal artery stenosis grades were evaluated. Kappa test was used to assess the consistency between the two methods. With CE-MRA as the reference, the diagnostic sensitivity, specificity, accuracy, PPV and NPV for IFIR-FIESTA were calculated in detecting renal artery stenosis. Results The images by the two methods were 100% qualified for diagnosis, although the image quality of CE-MRA was significantly better. IFIR-FIESTA and CE-MRA showed excellent consistency in detecting renal artery stenosis. With CE-MRA as the reference, the diagnostic sensitivity, specificity, accuracy, PPV and NPV for IFIR-FIESTA were 97.1%, 100%, 98.1%, 100%, and 95%in detecting renal artery stenosis, respectively. Conclusion IFIR-FIESTA is feasible as a routine examination for detecting renal artery stenosis in elderly patients.

Objective To explore the relationship between hormone therapy (HT) in women withovarian malignancy and prognosis. Methods HT was used in 31 patients with ovarian cancer after surgery,and 44 eases with ovarian eaneer served as controL The expression of estrogen receptor (ER)α, ERβ andprogesterone receptor (PR) was detected by immunohistoehemieal staining respectively. The level of serumealeitonin and transforming growth factor α (TGFα) was detected by radio-immune and enzyme-linkedimmunosorbent assay pre- or post-surgery, as well as half a year to one year later post-surgery respectively inthese eases. The survival curve of Kaplan-Meier and log-rank test as well as scale risk of Cox model wereused to analyze the relationship between HT and prognosis of ovarian cancer. Results ( 1 ) The results oflog-rank test showed that there was no difference in survival curve of patients with or without HT [ (1108±52), (1086±43) d; P=0.940] ; the results of scale risk of Cox model also showed that HT was not anindependent prognosis factor for patients with HT. (2) There was no relationship with HT and theaccumulated survival in patients with either positive or negative expression of ERa, ERβ and PR in tissue;as well as between HT and the level of serum TGFα pre-, post-surgery, or half a year to one year aftersurgery. (3) The level of serum caleitonin in patients without HT post-surgery half a year to one year laterwas higher than that pre-surgery [ (141±13), (95±11) μg/; P<0.05], but there was no significantdifference between patients with HT half a year to one year later past-surgery and pre-surgery [ (90±18)μg/L, (93±14) μ/L; P>0.05]. (4) There was a significant difference in body and emotion function between HT and without HT groups [(1.84±1.50), (1.45±0.82); (12.69±10.20), (12.90±11.61); P<0.05], as well as in sex quality and autonomic nerve maladjustment and in the special listmade [(1.05±0.74), (1.77±1.08); (10.10±3.21), (13.09±4.30); P<0.05]. ConclusionsThere is no adverse influence on prognosis in using of HT for patients with ovarian cancer after surgery. HTfor patients with ovarian cancer post-surgery can help keep a stable level of scmm calcitonin as well asimprove the quality of life.

Objective To investigate the peripheral blood cytopenias in patients with portal hypertension complicated with splenomegaly. Methods The clinical data of 309 patients with portal hypertension who had been admitted to our department from January 1991 to December 2006 were retrospeetively analyzed. Results Of all patients, 278 showed peripheral blood cytopenia, ineluding 71 with paneytopenia, 48 with leukocyte and platelet decrease, 25 with erythroeyte and platelet decrease, 33 with leukocyte and erythroeyte decrease, 28 with platelet decrease, 26 with leukocyte decrease, and 47 with erythrocyte deerease. The number of blood cells increased significantly after splenectomy ( t=6.53, P<0.01). The whole blood cells of the remaining 31 patients without hematocytopenia were normal. Conclusions Patients with portal hypertension eomplieated with splenomegaly do not always accompany peripheral blood eytopenia. Peripheral blood cytopenia is one of the complications of splenomegaly, hut it dose not always appear. Splenectomy is effective in the treatment of hematocytopenia. The reason for some patients do not have peripheral blood cytopenia may be related to the slight pathological changes of spleen and severe hyperplasia of bone marrow.

Professor CHAO En-xiang accumulates abundant clinical experience,thinks highly of syndrome differentiation and treatment in clinic,emphasizes the pathogeny and method of treatment in accordance with formula and Chinese medicine,notices avoiding to be limited by individual experience.He cautiously grasps pathogenesis in clinical diagnosis and treatment,and is good at applying the theories of TCM,emphasizes the application of the theory of the lung and the large intestine being interior-exteriorly related in treating lung system diseases.He is expert in treating acute diseases with purgative therapy. He learns from ancient physicians,but not limited by their academic thinking,and has formed the special thinking on syndrome differentiation and treatment.