ObjectiveTo investigate the mechanisms by which Bushen Tongluo Jiangzhuo prescription improves renal fibrosis in rats with chronic kidney disease （CKD） through the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway. MethodsSeventy specific pathogen-free （SPF） Sprague-Dawley （SD） rats were randomly divided into a control group （n=15） and a modeling group （n=55）. Rats in the modeling group were administered a 2.5% adenine suspension at a dose of 200 mg·kg^-1·d^-1 by gavage for 4 weeks to establish a CKD model. Successfully modeled rats were randomly divided into a model group， an irbesartan group （20.25 mg·kg^-1·d^-1）， and Bushen Tongluo Jiangzhuo prescription low-， medium-， and high-dose groups （5.82， 11.64， and 23.28 g·kg^-1·d^-1， respectively）， with 10 rats in each group. Each group was administered an equal volume of physiological saline， the corresponding concentration of irbesartan， or Bushen Tongluo Jiangzhuo prescription by gavage for 12 weeks. Body weight and renal function indices were dynamically monitored. Serum creatinine （SCr）， blood urea nitrogen （BUN）， urine albumin-to-creatinine ratio （ACR）， 24-hour urinary total protein （24 hUTP）， aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） levels were measured using an automatic biochemical analyzer. Renal histopathological changes were observed by hematoxylin-eosin （HE） and Masson staining. Immunohistochemistry （IHC） was used to detect the expression of PI3K， Akt， phosphorylated Akt （p-Akt）， and mTOR in renal tissues. Western blot was performed to assess the protein expression of PI3K， p-Akt， Akt， phosphorylated mTOR （p-mTOR）， and mTOR in renal tissues. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to determine the mRNA expression levels of PI3K， Akt， and mTOR in renal tissues. ResultsCompared with the model group， rats in the irbesartan group and the low-， medium-， and high-dose Bushen Tongluo Jiangzhuo prescription groups showed significantly decreased levels of SCr， BUN， ACR， 24 hUTP， IL-1β， IL-6， and TNF-α （P<0.01）. AST levels were significantly increased （P<0.01）， while no significant difference was observed in ALT levels. Histopathological examination revealed that， compared with the model group， renal tubular epithelial cell edema and necrosis and Bowman's capsule dilation were alleviated， inflammatory cell infiltration was reduced， and interstitial and glomerular fibrosis was markedly improved in all treatment groups， with the most pronounced effect observed in the high-dose Bushen Tongluo Jiangzhuo prescription group. Real-time PCR results showed that mRNA expression levels of PI3K， Akt， and mTOR were significantly downregulated in the high-dose group （P<0.01）. IHC results demonstrated that PI3K and p-Akt expression levels in renal tissues were significantly decreased in the high-dose group （P<0.01）. Western blot analysis further confirmed that the expression levels of PI3K， p-Akt/Akt， and p-mTOR/mTOR were significantly reduced in the high-dose group （P<0.01）. ConclusionBushen Tongluo Jiangzhuo prescription improves renal function indices in CKD rats， reduces collagen deposition in renal tissues， and decreases serum inflammatory factor levels. Its protective effect on renal function may be achieved by activating autophagy through downregulation of the PI3K/Akt/mTOR signaling pathway， thereby alleviating renal fibrosis.

Objective To investigate the changes in metabolites detected by magnetic resonance spectroscopy(MRS)in the dorsal thalamus of patients with cervical spondylotic myelopathy(CSM)and to analyze their correlation with spinal cord injury based on diffusion tensor imaging(DTI).Methods A total of 93 patients with CSM(patient group)and 67 healthy volunteers(control group)were selected.DTI parameters of the spinal cord and MRS parameters of the thalamus were compared between the two groups.Correlation analysis were performed among clinical features,conventional imaging features,DTI parameters,and metabolites in CSM patients.Multifacto-rial linear regression equations for thalamic metabolites based on the aforementioned characteristics were established.Results The fractional anisotropy(FA)value was significantly lower in the patient group than in the control group(P=0.005,t=2.874).The N-acetyl aspartate/creatine(NAA/Cr)ratio(P<0.001,Z=-5.922),choline/Cr(Cho/Cr)ratio(P<0.001,Z=-6.857),and myo-inositol/Cr(MI/Cr)ratio(P<0.001,Z=-6.573)were significantly lower in the patient group than in the control group.The NAA/Cr ratio(r=0.444,P<0.001),Cho/Cr ratio(r=0.308,P=0.003),and MI/Cr ratio(r=-0.489,P<0.001)were corre-lated with the FA value in the patient group.There was a correlation between the NAA/Cr ratio and the duration(r=-0.365,P<0.001).Multifactorial linear regression equations for each metabolites in the thalamus:NAA/Cr=0.833+1.520×FA-0.007×duration;Cho/Cr=0.209+0.774×FA;MI/Cr=1.566-1.722×FA+0.008×modified Japanese Orthopaedic Association(mJOA)score;glu-tamate/Cr(Glx/Cr)=0.942+0.009×duration.Conclusion CSM patients exhibit metabolic alterations in the dorsal thalamus,which are linearly correlated with the degree of spinal cord injury.

A traditional Chinese medicine(TCM)monomer is a bioactive compound extracted from Chinese herbal medicines possessing determined biological activity and pharmacological effects,and has gained much attention for treating neuronal diseases.However,the application of TCM monomers is limited by their low solubility and poor ability to cross the blood-brain barrier(BBB).Exosomes are small extracellular vesicles(EVs)ranging in size from 30 to 150 nm in diameter and can be used as drug delivery carriers that directly target cells or tissues with unique advantages,including low toxicity,low immunogenicity,high stability in blood,and the ability to cross the BBB.This review discusses the biogenesis,components,stability,surface modification,isolation technology,advantages,and disadvantages of exosomes as drug carriers and compares exosomes and other similar drug delivery systems.Furthermore,exosome-encapsulated TCM monomers exert neuroprotective roles,such as anti-inflammation,anti-apoptosis,anti-mitophagy,and anti-oxidation,in various neuronal diseases,including Alzheimer's disease(AD),Parkinson's disease(PD),multiple sclerosis(MS),and cerebral ischemia and reperfusion(CI/R)injury,as well as anti-drug resistance,anti-tumorigenesis,anti-angiogenesis,and promotion of apoptosis in brain tumors,providing more inspiration to promote the development of an exosome-based delivery tool in targeted therapy for neuronal diseases.

A traditional Chinese medicine (TCM) monomer is a bioactive compound extracted from Chinese herbal medicines possessing determined biological activity and pharmacological effects, and has gained much attention for treating neuronal diseases. However, the application of TCM monomers is limited by their low solubility and poor ability to cross the blood-brain barrier (BBB). Exosomes are small extracellular vesicles (EVs) ranging in size from 30 to 150 nm in diameter and can be used as drug delivery carriers that directly target cells or tissues with unique advantages, including low toxicity, low immunogenicity, high stability in blood, and the ability to cross the BBB. This review discusses the biogenesis, components, stability, surface modification, isolation technology, advantages, and disadvantages of exosomes as drug carriers and compares exosomes and other similar drug delivery systems. Furthermore, exosome-encapsulated TCM monomers exert neuroprotective roles, such as anti-inflammation, anti-apoptosis, anti-mitophagy, and anti-oxidation, in various neuronal diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), and cerebral ischemia and reperfusion (CI/R) injury, as well as anti-drug resistance, anti-tumorigenesis, anti-angiogenesis, and promotion of apoptosis in brain tumors, providing more inspiration to promote the development of an exosome-based delivery tool in targeted therapy for neuronal diseases.

Objective To understand the current situation of the management of patients'self-provided infusion drugs in secondary and above general hospitals in China,and to provide a theoretical and practical basis for improving the management system.Methods The annual pharmacy professional quality control work survey conducted by the National Pharmaceutical Management Professional Quality Control Center was used to obtain information on the management of patients'self-provided infusion drugs in secondary and above general hospitals in 31 provinces(autonomous regions and municipalities directly under the central government)and the Xinjiang Production and Construction Corps of Chinese mainland from 2020 to 2022,and was summarized and calculated using data-processing software.Results The total number of secondary and above general hospitals included in the analysis from 2020 to 2022 is 4 786,5 063 and 6 041,respectively.In 2022,compared with 2020,the percentage of hospitals allowing patients to use self-provided infused drugs decreased from 55.08％to 48.54％,the percentage of hospitals that have established a system for managing patients' self-provided drugs increased from 81.54％to 98.09％,and the percentage of hospitalized patients' use of self-provided drugs that are all documented in their medical orders increased from 79.76％to 90.72％.The types of drugs that hospitals allow patients to use for self-provided infusion are mainly antitumor drugs,the places where self-provided infusion drugs are dispensed are mainly clinical departments(wards),and the main source of self-provided infusion drugs is self-pickup by patients.Conclusion Hospitals should establish a management system for patients'self-provided drugs,strengthen the information management of self-provided infusion drugs,and ensure drug supply and medication safety for patients.

ObjectiveTo investigate the clinical efficacy and potential mechanism of Shengmai Jiuxin decoction in the treatment of acute decompensated heart failure （ADHF） with the traditional Chinese medicine （TCM） pattern of Qi and Yin deficiency， Yang deficiency， and blood stasis. MethodsA total of 68 patients diagnosed with ADHF of Qi and Yin deficiency， Yang deficiency， and blood stasis type were randomly assigned to an observation group （34 cases） and a control group （34 cases）. Both groups received conventional Western medical treatment， while the observation group was additionally administered Shengmai Jiuxin decoction. Parameters compared before and after treatment included： TCM syndrome score， TCM syndrome efficacy， New York Heart Association （NYHA） functional classification， left ventricular ejection fraction （LVEF）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， six-minute walk distance （6MWD）， hypoxia-inducible factor-1 alpha （HIF-1α）， vascular endothelial growth factor A （VEGF-A）， Caspase-3， and the number of rehospitalizations for heart failure within one month after discharge. ResultsThere were no significant differences in sex， age， vital signs， or underlying diseases between the two groups. Compared with baseline， both groups exhibited significant reductions in TCM syndrome scores， NT-proBNP， and HIF-1α levels （P<0.01）， as well as significant increases in 6MWD， LVEF， VEGF-A， and Caspase-3 levels （P<0.05， P<0.01）. After treatment， the observation group showed significantly greater reductions in TCM syndrome score， NT-proBNP， HIF-1α， and Caspase-3 levels compared with the control group （P<0.05） and significantly greater increases in 6MWD， TCM syndrome efficacy， and VEGF-A levels （P<0.05）. No significant differences were observed between the groups in NYHA functional classification， LVEF， or the number of rehospitalizations for heart failure within one month after discharge. No drug-related adverse events were reported in either group during the treatment period. ConclusionShengmai Jiuxin decoction can improve cardiac function and clinical symptoms in patients with ADHF of Qi and Yin deficiency， Yang deficiency， and blood stasis type. Its mechanisms may be related to the regulation of the HIF-1 signaling pathway by modulating targets such as HIF-1α， VEGF-A， and Caspase-3.

ObjectiveTo investigate the clinical efficacy and potential mechanism of Shengmai Jiuxin decoction in the treatment of acute decompensated heart failure （ADHF） with the traditional Chinese medicine （TCM） pattern of Qi and Yin deficiency， Yang deficiency， and blood stasis. MethodsA total of 68 patients diagnosed with ADHF of Qi and Yin deficiency， Yang deficiency， and blood stasis type were randomly assigned to an observation group （34 cases） and a control group （34 cases）. Both groups received conventional Western medical treatment， while the observation group was additionally administered Shengmai Jiuxin decoction. Parameters compared before and after treatment included： TCM syndrome score， TCM syndrome efficacy， New York Heart Association （NYHA） functional classification， left ventricular ejection fraction （LVEF）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， six-minute walk distance （6MWD）， hypoxia-inducible factor-1 alpha （HIF-1α）， vascular endothelial growth factor A （VEGF-A）， Caspase-3， and the number of rehospitalizations for heart failure within one month after discharge. ResultsThere were no significant differences in sex， age， vital signs， or underlying diseases between the two groups. Compared with baseline， both groups exhibited significant reductions in TCM syndrome scores， NT-proBNP， and HIF-1α levels （P<0.01）， as well as significant increases in 6MWD， LVEF， VEGF-A， and Caspase-3 levels （P<0.05， P<0.01）. After treatment， the observation group showed significantly greater reductions in TCM syndrome score， NT-proBNP， HIF-1α， and Caspase-3 levels compared with the control group （P<0.05） and significantly greater increases in 6MWD， TCM syndrome efficacy， and VEGF-A levels （P<0.05）. No significant differences were observed between the groups in NYHA functional classification， LVEF， or the number of rehospitalizations for heart failure within one month after discharge. No drug-related adverse events were reported in either group during the treatment period. ConclusionShengmai Jiuxin decoction can improve cardiac function and clinical symptoms in patients with ADHF of Qi and Yin deficiency， Yang deficiency， and blood stasis type. Its mechanisms may be related to the regulation of the HIF-1 signaling pathway by modulating targets such as HIF-1α， VEGF-A， and Caspase-3.

Objective To investigate the value of the nomogram model based on the apparent diffusion coefficient(ADC)value of the cervical spinal cord in predicting neurological recovery after cervical spondylotic myelopathy(CSM).Methods One hundred CSM patients undergoing decompression surgery were prospectively enrolled.All patients underwent conventional cervical spine MRI and sagittal position non-shared incentive diffusion weighted imaging(ZOOM-DWI)examination before surgery.The improvement rate of neurological function was calculated according to the modified Japanese Orthopaedic Association(mJOA)score before and 6 months after surgery and divided into the good improvement group(60 patients)and the poor improvement group(40 patients)according to the improvement rate.Independent risk factors for postoperative outcomes were determined by univariate and multivariate logistic regression.Then the prediction model based on the clinical-imaging feature(model 1)and clinical-imaging feature-ADC value(model 2)were established,the receiver operating characteristic(ROC)curve was drawn,and the DeLong test was performed to compare the discrimination efficiency of the two models.A nomogram,calibration curve,and clinical decision curve were drawn for model 2.Results Age,body mass index(BMI),diabetes mellitus,T2 hyperintense,cross-sectional area,and ADC values at the disc level of different segments were independent risk factors affecting the outcome of CSM.The area under the curve(AUC)of the ROC curve constructed by model 2(AUC=0.933)was higher than that of model 1(AUC=0.864).The DeLong test showed that the difference between the two models was statistically significant(P＜0.05).The nomogram,calibration curve,and decision curve analysis(DCA)of model 2 showed that it had good differentiation,accuracy,and clinical value.Conclusion The nomogram model based on ADC value can effectively predict the outcome of postoperative neurological recovery in CSM patients.

OBJECTIVE To explore the potential mechanisms of forkhead box protein A1(FOXA1)in benzo[a]pyrene(BaP)-induced carcinogenesis by investigating the effect of FOXA1 by knockout on microRNA(miRNA)expression profiles in BaP malignant transformed cells THBEc1 and establishing regulatory networks between FOXA1,miRNA and their target genes.METHODS FOXA1 knockout THBEc1 cells THBEc1-ΔFOXA1-c34 and control cells THBEc1-ctrl were used as study models.Western blotting was employed to determine FOXA1 protein expression levels.Next-generation sequencing(NGS)tech-nology was used to identify differentially expressed miRNAs between THBEc1-ΔFOXA1-c34 and THBEc1-ctrl cells,with subsequent validation by RT-qPCR.Five databases(ENCORI,miRDB,mirDIP,miRWalk and TargetScan 8.0)were used in conjunction with NGS results of mRNA between THBEc1-ΔFOXA1-c34 and THBEc1-ctrl to predict different expressed genes(DEGs)regulated by the identified differentially expressed miRNAs.GO and KEGG enrichment analyses were conducted on the DEGs using the DAVID database.Interaction network analysis of the proteins encoded by the DEGs was performed using STRING 12.0 and Cytoscape 3.10.2 software.RESULTS No FOXA1 expression was detected in THBEc1-ΔFOXA1-c34 cells.A differential analysis of miRNA expressions revealed 33 miRNAs with a fold change of＞2 or＜0.5 and a false discovery rate of＜0.05 between THBEc1-ΔFOXA1-c34 and THBEc1-ctrl cells,13 of which were down-regulated and 20 were up-regulated in THBEc1-ΔFOXA1-c34 cells.A regulatory network was formed by 11 down-regulated miRNAs and 32 up-regulated mRNAs,while a second network included 16 up-regulated miRNAs and 56 down-regulated mRNAs.The 27 differentially expressed miRNAs participated in various biological processes through the regulation of 88 DEGs,primarily associated with cell growth,proliferation,migration,apoptosis,angiogenesis,epithe-lial-mesenchymal transition,and signal transduction(TGF-β,Hippo,NF-kappa B and MAPK pathways).CONCLUSION The miRNA expression profile in BaP-malignant transformed THBEc1 cells is altered following FOXA1 knockout that may disrupt TGF-β and MAPK signaling pathways by changing miRNA expression levels,thereby inhibiting cell proliferation and migration.

Objective To investigate the relationship between quantitative parameters of the histogram of global fat fraction(FF)in the infrapatellar fat pad(IPFP)and the severity of knee osteoarthritis(KOA).Methods A total of 120 patients were prospectively selected and divided into the non-KOA group(KL grade 0-1),the mild KOA group(KL grade 2),and the severe KOA group(KL grade 3-4)based on the Kellgren-Lawrence(KL)classification criteria of knee X-rays.The FF maps of the IPFP were obtained based on the mDIXON-Quant technique.The region of interest(ROI)was delineated using 3D Slicer software,and global histogram analysis was performed to obtain quantitative parameters,including mean,median,10th percentile(10th),90th percentile(90th),skewness,kurtosis,and entropy.Pearson or Spearman correlation analysis was used to evaluate the correlation between each quanti-tative parameter and the severity of KOA.The diagnostic efficacy was analyzed using the receiver operating characteristic(ROC)curves.Results As the progression of KL classification,the mean,median,percentiles,and kurtosis of the global FF histogram quantitative parameters in the IPFP decreased,while skewness and entropy increased,with statistically significant among the three groups(P＜0.001).The mean,median,10th,90th,and kurtosis showed negative correlations with the KL classification(r=-0.563,-0.448,-0.614,-0.294,-0.450),while skewness and entropy showed positive correlations with the KL classification(r=0.385,0.637),all of which were statistically significant(P＜0.05).The area under the curve(AUC)for diagnosing KOA were 0.799,0.725,0.828,0.636,0.741,0.688,and 0.830,respectively.The sensitivity of the 10th and entropy were 74.4％and 77.9％,respectively,and the specificity were 85.3％and 88.2％,respectively.Conclusion The quantitative parameters of the histogram of global FF in the IPFP are correlated with the severity of KOA and can reflect the pathophysiological changes in the IPFP.They can serve as objective indicators for diagnosing KOA and assessing its severity.