Gouty arthritis （GA） is caused by monosodium urate（MSU） deposition due to purine metabolism disorders. In traditional Chinese medicine （TCM）， it falls under the category of "dampness-heat Bi syndrome"， with core pathogenesis involving dampness-heat accumulation and dysfunction of the spleen and kidney. The dampness-heat syndrome is the most common and the primary syndrome type during acute attacks. In Western medicine， GA is associated with purine metabolism imbalance and inflammation triggered by MSU crystals， involving pathways such as NOD-like receptor protein 3 （NLRP3） inflammasome activation and Toll-like receptor 2/4 （TLR2/4） signaling. Clinically， colchicine and similar drugs are commonly used to treat GA， although long-term use carries potential side effects. Ermiao Formula analogs originate from ancient prescriptions， including Ermiao， Sanmiao， and Simiao compound formulas. All contain Atractylodis Rhizoma and Phellodendri Chinensis Cortex. Ermiaowan follow a 1∶1 formulation ratio. Sanmiaowan add Cyathulae Radix. Simiaowan further incorporate Coicis Semen. These formulas are rich in active ingredients， including alkaloids， terpenoids， flavonoids， and sterols， and treat GA through multi-component， multi-pathway， and multi-target mechanisms. Ermiaosan primarily exerts anti-inflammatory effects by inhibiting pathways such as TLR4/nuclear factor kappa-B （NF-κB） or regulating immune responses to reduce the release of inflammatory mediators， while also suppressing xanthine dehydrogenase （XDH） and xanthine oxidase （XO） activity to decrease uric acid production. Sanmiaowan enhance uric acid-lowering and anti-inflammatory effects through the guiding herb Cyathulae Radix， while also protecting cartilage from damage. Simiaowan utilizes Coicis Semen to regulate intestinal flora， alleviate dampness-heat symptoms， and exert multi-pathway anti-inflammatory and uric acid-lowering effects. The active ingredients contribute differently to uric acid metabolism regulation， anti-inflammation， antioxidant activity， and bone repair， resulting in varying therapeutic effects due to differences in formula composition. In summary， formulas derived from Ermiaosan demonstrate significant efficacy in treating dampness-heat type GA. This review summarizes their research progress and mechanisms， providing a reference for clinical application， new drug development， and further studies.

"Dietary inquiry" is a core component of the diagnostic system in traditional Chinese medicine （TCM）， which can be divided into three aspects including appetite， eating capacity， and food preference. Abnormalities in appetite are mainly attributed to dysfunction of the mind and impaired regulatory mechanisms. Clinical inquiry should focus on hunger sensation and the willingness to eat voluntarily. Treatment should aim to soothe the liver， regulate the spleen， nourish and calm the mind. Abnormalities in eating capacity are related to disorders of qi movement and structural dysfunction， for which inquiry should focus on whether food descends smoothly and on postprandial reactions， and the corresponding treatment is descending qi， relieving fullness， and promoting bowel movement and digestion. Abnormalities in food preference arise from damage caused by the five flavors and imbalance of visceral qi， for which inquiry should focus on dietary preferences and whether eating brings comfort. It is important to distinguish between "stomach preference" and "oral preference"， and treatment should carefully differentiate flavor tendencies and correct imbalances through appropriate dietary flavors. By refining the content of dietary inquiry， this study explores how different dimensions of eating status reflect the holistic concept and syndrome differentiation-based treatment in TCM， providing a reference for the clinical diagnosis and treatment of spleen and stomach diseases and related disorders.

"Dietary inquiry" is a core component of the diagnostic system in traditional Chinese medicine （TCM）， which can be divided into three aspects including appetite， eating capacity， and food preference. Abnormalities in appetite are mainly attributed to dysfunction of the mind and impaired regulatory mechanisms. Clinical inquiry should focus on hunger sensation and the willingness to eat voluntarily. Treatment should aim to soothe the liver， regulate the spleen， nourish and calm the mind. Abnormalities in eating capacity are related to disorders of qi movement and structural dysfunction， for which inquiry should focus on whether food descends smoothly and on postprandial reactions， and the corresponding treatment is descending qi， relieving fullness， and promoting bowel movement and digestion. Abnormalities in food preference arise from damage caused by the five flavors and imbalance of visceral qi， for which inquiry should focus on dietary preferences and whether eating brings comfort. It is important to distinguish between "stomach preference" and "oral preference"， and treatment should carefully differentiate flavor tendencies and correct imbalances through appropriate dietary flavors. By refining the content of dietary inquiry， this study explores how different dimensions of eating status reflect the holistic concept and syndrome differentiation-based treatment in TCM， providing a reference for the clinical diagnosis and treatment of spleen and stomach diseases and related disorders.

ObjectiveTo investigate the mechanism of Guizhi Fulingwan （GFW） against hepatic fibrosis， focusing on elucidating the regulatory effect of GFW on the mitochondrial DNA （mtDNA）/NOD-like receptor protein 3 （NLRP3）/cysteinyl aspartate-specific proteinase-1 （Caspase-1）/gasdermin D （GSDMD） signaling pathway. MethodsForty-two male Sprague-Dawley （SD） rats were randomly allocated into six groups （n=7）： control， model， low/medium/high-dose （0.14， 0.28， 0.56 g·kg^-1·d^-1） GFW （GFW-L， GFW-M， GFW-H）， and Dahuang Zhechong pills （DZW， 1.8 g·kg^-1·d^-1）. The rat model of hepatic fibrosis was induced by intraperitoneal injection of carbon tetrachloride. General conditions of the rats were observed. Serum levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） levels were measured. Liver histopathology and collagen deposition were observed through hematoxylin and eosin （HE） staining and Masson's trichrome staining. Transmission electron microscopy （TEM） was employed to observe structural alterations and damage of cellular ultrastructures including mitochondria. Mitochondrial membrane potential （MMP， ΔΨ_m） was detected by flow cytometry. Serum levels of interleukin-1β （IL-1β） and interleukin-18 （IL-18） were measured by enzyme-linked immunosorbent assay （ELISA）. The mRNA levels of mtDNA and NLRP3 in the liver tissue were quantified by Real-time polymerase chain reaction （Real-time PCR）. The protein levels of key molecules in the NLRP3/Caspase-1/GSDMD signaling pathway in the liver tissue were determined by Western blot. ResultsCompared with the control group， the model group exhibited a decrease in body weight （P<0.01）， an increase in liver index （P<0.01）， elevations in serum ALT and AST levels （P<0.01）， and typical fibrotic features such as disorganized hepatocytes， inflammatory infiltration， and increased collagen deposition in the liver tissue. TEM revealed significant karyotheca degeneration， mitochondrial swelling， endoplasmic reticulum expansion， and organelle efflux in the model group. In addition， the model group showed decreased ΔΨ_m （P<0.01）， up-regulated mRNA levels of mtDNA and NLRP3 （P<0.01） and protein levels of NLRP3， Caspase-1， and GSDMD （P<0.01） in the liver tissue， and increased serum levels of IL-1β and IL-18 （P<0.01）. Compared with that in the model group， the body weight increased in GFW-L， GFW-M， and DZW groups （P<0.05） and markedly increased in the GFW-H group （P<0.01）. The liver index decreased in the GFW groups and DZW group （P<0.01）. The serum ALT level declined in the GFW-L group （P<0.05）， and the serum ALT and AST levels decreased in the GFW-M， GFW-H， and DZW groups （P<0.01）. Histopathological damage and fibrosis were alleviated to varying degrees， and TEM revealed mitigated ultrastructural injuries including mitophagy， mitochondrial swelling， and endoplasmic reticulum expansion in the drug intervention groups. The ΔΨ_m increased in GFW groups without statistical significance. The mRNA level of mtDNA in the liver tissue was down-regulated in the GFW-M （P<0.05）， GFW-H （P<0.01）， and DZW （P<0.01） groups. The mRNA level of NLRP3 was down-regulated in GFW-M， GFW-H， and DZW groups （P<0.01）. Western blot analysis showed significantly down-regulated protein level of NLRP3 in all the GFW groups and the DZW group （P<0.01）. The protein level of GSDMD-N was down-regulated in GFW-H and DZW groups （P<0.01）. The protein level of cleaved Caspase-1 was down-regulated in GFW-M （P<0.05）， GFW-H （P<0.01）， and DZW （P<0.01） groups. In addition， the serum levels of IL-1β and IL-18 declined in GFW-H and DZW groups （P<0.01）. ConclusionGFW can suppress pyroptosis to ameliorate CCl₄-induced hepatic fibrosis， potentially through mitigating mitochondrial damage， inhibiting inflammasome assembly and activation， and blocking pro-inflammatory cytokine release.

Objective To investigate the effect of combination therapy of evolocumab and statins on blood lipids,liver and renal functions and occurrence of cardiovascular events in elderly patients with multi-vessel coronary heart disease(CHD).Methods A total of 108 elderly patients with multi-vessel CHD admitted to our hospital from January 2022 to January 2023 were enrolled and randomly divided into statin group(54 cases)and combination group(atorvastatin+evolocumab,54 cases).The clinical efficacy,changes in blood lipids before and after treatment[TC,LDL-C and LP(a)],angina pectoris status[attack frequency and duration,Seattle angina questionnaire(SAQ)score],indicators of liver and renal functions(Scr,ALT,AST),endothelial function indi-cators(NO,ET-1),blood-related biochemical indicators[proprotein convertase subtilisin/kexin type 9(PCSK9),soluble intercellular adhesion molecule-1(sICAM-1)],and incidence rates of ad-verse drug reactions and major adverse cardiovascular events(MACE)within 1 year were com-pared between the two groups.Results The total efficacy was significantly higher in the combina-tion group than the statin group(94.4％vs 81.5％,P＜0.05).There were no statistical differences in the levels Scr,ALT and AST in both groups before and after treatment(P＞0.05).After treat-ment,the levels of TC,LDL-C and Lp(a),frequency and duration of angina attack,and levels of ET-1,PCSK9 and sICAM-1 were significantly decreased,while SAQ score and NO level were ob-viously increased in both groups(P＜0.01).The combination group had notably lower frequency and shorter duration of angina attack,reduced levels of TC,LDL-C and Lp(a),and ET-1,PCSK9 and sICAM-1,and higher SAQ score and elevated NO level when compared with the statin group(P＜0.01).No statistical difference was seen in the incidence of adverse drug reactions between the two groups(13.0％vs 9.3％,P＞0.05).Within 1 year after treatment,the incidence of MACE in the combination group was notably lower than that in the statin group(3.7％vs 16.7％,P＜0.05).Conclusion Evolocumab has a significant lipid-lowering effect on elderly patients with multi-vessel CHD.It can significantly promote lipid metabolism,alleviate angina pectoris symp-toms,and improve vascular endothelial function and the prognosis outcomes,with good safety,which is worthy of application.

Objective:To investigate the semen characteristics of male patients with autosomal dominant polycystic kidney disease (ADPKD) complicated by infertility and the impact of PKD1 mutations on their reproductive outcomes following preimplantation genetic testing for monogenic diseases (PGT-M). Methods:A retrospective cohort study was conducted to analyze the clinical data of ADPKD patients in the Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2023. The study included two groups: observation group consisting of male infertility patients with ADPKD aged 20-45 years ( n=78), and control group comprising ADPKD patients with PKD1 mutations who demonstrated normal semen parameters ( n=5). According to the type of mutation, the patients were further divided into the PKD1 truncated mutation group and the non-truncated mutation group. Baseline data, ovulation induction outcomes and PGT-M clinical outcomes were compared between the two groups. Binary logistic regression analysis was used to assess the effects of age, family history, mutation type and mutation position on semen quality and live birth rates. Results:In the observation group, there were 28 cases of asthenozoospermia, 38 cases of oligoasthenozoospermia, and 12 cases of azoospermia. The total sperm count and forward motility ratio of patients with asthenozoospermia, oligoasthenozoospermia, and azoospermia in the observation group were significantly different from those in control group (all P<0.001). Genetic diagnosis revealed PKD1 mutations in 70 cases, PKD2 mutation in 1 case, and no known pathogenic mutations were identified in 7 cases. Among the 70 ADPKD patients with PKD1 mutations, 52 couples underwent PGT-M assisted reproduction. The blastocyst formation rate was significantly lower in the non-truncating mutation group [44.74% (51/114)] than in the truncating mutation group [58.76% (161/274), P=0.011]. No statistically significant differences were observed between the two groups in other parameters including age of both partners, semen parameters, number of oocytes retrieved, two pronuclei (2PN) rate, number of available embryos, high-quality embryo rate, clinical pregnancy rate, miscarriage rate, and live birth rate (all P>0.05). Binary logistic regression analysis showed that neither PKD1 mutation type nor PKD1 mutation site was an independent factor affecting semen parameters and live birth rate in ADPKD patients (all P>0.05). Conclusions:Asthenospermia and oligoasthenospermia are the most common semen phenotypes in ADPKD-associated male infertility. The PKD1 mutation type and location are not associated with abnormal semen parameters in ADPKD-associated infertility patients. PKD1 mutation types do not affect the outcomes of PGT-M in infertile patients with ADPKD.

AIM:To observe the changes of atrial fibrillation susceptibility,and the remodeling of atrial myo-cyte action potential,ultrarapid activation delayed rectifier potassium current(IKur)and transient outward potassium cur-rent(Ito)in elderly mice,and to explore the mechanism of atrial fibrillation from the single cell electrophysiological level.METHODS:The C57BL/6J mice were divided into old group(20 months old)and young group(4 months old).Atrial fi-brillation was induced by esophageal atrial pacing.The atrial myocytes were isolated,and action potential and ion currents were recorded with patch-clamp technique.The associated proteins were detected by Western blot technique.RE-SULTS:(1)Compared with young mice,the total incidence of atrial fibrillation was significantly increased in old mice(20.0%at 4 months old vs 60.0%at 20 months old,P<0.01).(2)The action potential duration of atrial myocytes in aged mice was shortened,and more significantly after stimulation.(3)The density of Ito and IKur in atrial myocytes of aged mice increased significantly,from(12.6±1.4)pA/pF to(21.7±1.1)pA/pF,and from(7.5±1.5)pA/pF to(13.3±2.1)pA/pF,respectively(P<0.01).After stimulation,the current increased more significantly,especially in older atrial cells.Compared with the young mice,the steady-state activation curve of Ito in the atrial myocytes of the aged mice shifted towards the depolarization,suggesting that activation of Ito channels in the aged mice increased at the same voltage stimula-tion.(4)Compared with young group,the expression of KV4.2(generating Ito)and KV1.5(generating IKur)proteins in the atrial tissue of the mice in old group was significantly increased,and the expression of caveolin-3 and end-binding protein 1(EB1)was up-regulated,suggesting that the increases in KV4.2 and KV1.5 total channel proteins and effective proteins in the cell membrane might contribute to the increase in the remodeling of potassium currents in the elderly atrial myo-cytes.CONCLUSION:The incidence of atrial fibrillation in elderly mice is significantly augmented,which may be related to the increases in Ito and IKur in atrial myocytes.The remodeling of potassium currents in elderly atrial myocytes is one of the electrophysiological bases leading to the shortening of action potential duration and the occurrence of atrial fibrillation.

Objective:To construct a meridian tapping exercise program for frail elderly, so as to provide daily healthcare options for frail elderly people.Methods:Guided by the theory of meridians and collaterals, data mining was conducted on the database of ancient Chinese medical literature to select acupoints and meridians for tapping. Through literature research, the exercise prescription was improved. A preliminary exercise prescription was formulated through literature review and revised through two rounds of expert consultation in December 2023.Results:The effective response rate for both rounds of expert consultation questionnaires was 7/7. The expert authority coefficients were 0.83 and 0.87, respectively, and the overall Kendall′s coefficient of concordance was 0.301 and 0.302 (both P<0.05). The final meridian tapping exercise for frail elderly comprised 2 primary indicators, 8 secondary indicators, and 23 tertiary indicators. Conclusions:The meridian tapping exercise for the frail elderly is scientific, reliable and practical, which can provide a choice for the frail elderly to carry out targeted traditional Chinese medicine exercises.

Objective To observe the effects of transcranial direct current stimulation(tDCS)combined with music therapy on cognitive function and activities of daily living in patients with post-stroke cognitive impairment(PSCI).Methods This prospective study enrolled subacute stroke(2 weeks to 6 months after onset)patients with cognitive impairment admitted to the Rehabilitation Department of the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from January 2023 to December 2024.Using the random number table,patients in the subacute early stage(2 weeks to＜3 months after stroke)and subacute late stage(3 months to 6 months after stroke)were respectively assigned to the experimental group and the control group.Baseline clinical data were collected,including gender,age,stroke type(intracerebral hemorrhage,cerebral infarction),lesion side(left,right),disease course,educational attainment,history of smoking and alcohol consumption,stroke area(basal ganglia,temporal lobe,frontal lobe),and National Institutes of Health stroke scale(NIHSS)score at admission.Both groups received conventional rehabilitation treatment.The experimental group additionally received tDCS treatment combined with music therapy intervention,which included active and passive music therapy.In contrast,the control group received only tDCS treatment in conjunction of conventional rehabilitation intervention.Both groups received treatment for 2 weeks.The Montreal cognitive assessment scale(MoCA),Rivermead behavioural memory test(RBMT),and digit span test(DST)were used to evaluate the overall cognitive function,memory,and attention of PSCI patients before and after treatment.The modified Barthel index(MBI)was used to evaluate the daily living activity ability of PSCI patients 2 weeks post-treatment.Results A total of 40 PSCI patients were included in this study,with 20 cases in each group.Among the participants,17 in the experimental group and 18 in the control group were in early stage of subacute stroke,while 3 in the experimental group and 2 in the control group were in the late stage of subacute stroke.(1)There were no statistically significant differences in the baseline clinical data of the two groups(all P＞0.05).(2)Before treatment,the MoCA,RBMT,and DST scores in the experimental group were(15.00±3.71),(2.90±1.07),and(4.05±1.47)points,respectively,while the corresponding scores in the control group were(13.45±2.61),(2.75±0.77),and(3.35±0.99)points.There were no statistically significant differences in the MoCA,RBMT,and DST scores between the two groups before treatment(all P＞0.05).Two weeks after treatment,the MoCA,RBMT,and DST scores in the experimental group were(19.05±4.35),(5.15±1.50),and(5.85±1.66)points,respectively,compared to(15.90±2.73),(3.45±1.15),and(4.35±1.18)points in the control group.The interaction effect of time and group(Ftime×group)was 15.716,45.762 and 14.140,respectively,all of which were statistically significant(all P＜0.01);the group main effect(Fgroup)was 4.876,7.140,and 7.074,respectively,all of which were statistically significant(all P＜0.05);the time main effect(Ftime)was 259.370,165.762,and 173.209,respectively,all of which were statistically significant(all P＜0.01).(3)Before treatment,the MBI scores of the experimental group and control group were(56.00±7.18)and(55.25±5.73)points,respectively,with no statistically significant difference between the two groups(P＞0.05).Two weeks after the treatment,the MBI scores of the experimental group and control group were(63.00±6.77)and(60.50±5.36)points,respectively.No statistically significant differences were observed in the interaction effect of time and group,or the main effect of group between the two groups after treatment(Ftime ×group=1.677,P＞0.05;Fgroup=0.751,P＞0.05).While a statistically significant difference was found in the main effect of time on the MBI scores between the experimental group and control group(Ftime=82.196,P＜0.01).Conclusion The combination of tDCS and music therapy can improve the cognitive function and daily living activity ability in patients with PSCI,and offering superior outcomes compared to tDCS treatment alone.

AIM:To observe the changes of atrial fibrillation susceptibility,and the remodeling of atrial myo-cyte action potential,ultrarapid activation delayed rectifier potassium current(IKur)and transient outward potassium cur-rent(Ito)in elderly mice,and to explore the mechanism of atrial fibrillation from the single cell electrophysiological level.METHODS:The C57BL/6J mice were divided into old group(20 months old)and young group(4 months old).Atrial fi-brillation was induced by esophageal atrial pacing.The atrial myocytes were isolated,and action potential and ion currents were recorded with patch-clamp technique.The associated proteins were detected by Western blot technique.RE-SULTS:(1)Compared with young mice,the total incidence of atrial fibrillation was significantly increased in old mice(20.0%at 4 months old vs 60.0%at 20 months old,P<0.01).(2)The action potential duration of atrial myocytes in aged mice was shortened,and more significantly after stimulation.(3)The density of Ito and IKur in atrial myocytes of aged mice increased significantly,from(12.6±1.4)pA/pF to(21.7±1.1)pA/pF,and from(7.5±1.5)pA/pF to(13.3±2.1)pA/pF,respectively(P<0.01).After stimulation,the current increased more significantly,especially in older atrial cells.Compared with the young mice,the steady-state activation curve of Ito in the atrial myocytes of the aged mice shifted towards the depolarization,suggesting that activation of Ito channels in the aged mice increased at the same voltage stimula-tion.(4)Compared with young group,the expression of KV4.2(generating Ito)and KV1.5(generating IKur)proteins in the atrial tissue of the mice in old group was significantly increased,and the expression of caveolin-3 and end-binding protein 1(EB1)was up-regulated,suggesting that the increases in KV4.2 and KV1.5 total channel proteins and effective proteins in the cell membrane might contribute to the increase in the remodeling of potassium currents in the elderly atrial myo-cytes.CONCLUSION:The incidence of atrial fibrillation in elderly mice is significantly augmented,which may be related to the increases in Ito and IKur in atrial myocytes.The remodeling of potassium currents in elderly atrial myocytes is one of the electrophysiological bases leading to the shortening of action potential duration and the occurrence of atrial fibrillation.