AIM: To investigate the differences in morphological structure and retinal blood perfusion between the affected eye and the contralateral healthy eye using optical coherence tomography angiography(OCTA)in patients with idiopathic macular epiretinal membrane(IMEM)before and after surgery, and to evaluate the association of these parameters with functional and anatomical outcomes to inform prognostic assessment. METHODS:A prospective study was conducted at Zhejiang Provincial People's Hospital between January 2023 and December 2024. Consecutive patients diagnosed with unilateral IMEM were enrolled; the fellow eye served as an internal control. All participants underwent standardized ophthalmic evaluations, including optical coherence tomography(OCT), OCTA, and color fundus photography. Key quantitative parameters assessed included best-corrected visual acuity(BCVA), central macular thickness(CMT), foveal avascular zone(FAZ)area, vessel density in the inner capillary plexus(ICP), superficial capillary plexus(SCP), deep capillary plexus(DCP), and choroidal capillary perfusion area(CCPA). Measurements were obtained preoperatively and at 1 and 3 mo postoperatively. Correlation analyses were performed between the above parameters and postoperative BCVA and CMT.RESULTS: This study enrolled 30 patients(60 eyes)diagnosed with IMEM, comprising 14 males and 16 females, with a mean age of 65.4±10.8 y.At baseline, IMEM-affected eyes demonstrated significantly reduced BCVA, DCP density, and FAZ area, alongside significantly increased CMT and CCPA, compared with contralateral controls. Following vitrectomy with membrane peeling, CMT decreased significantly at both 1 and 3 mo(both P<0.05)postoperatively; DCP density and BCVA showed significant improvement(both P<0.05). No significant change in FAZ area was observed postoperatively(P>0.05). At 3 mo postoperatively, BCVA of the affected eye was negatively correlated with CMT(r=-0.549, P=0.022). At 1 mo postoperatively, CMT was negatively correlated with preoperative DCP and FAZ, positively correlated with preoperative CMT, and positively correlated with ICP and SCP at 1 mo postoperatively, and negatively correlated with FAZ at 1 mo postoperatively(all P<0.05). Furthermore, CMT at 3 mo postoperatively was negatively correlated with preoperative DCP(r=-0.498,P=0.042).CONCLUSION:In patients with IMEM, the affected eyes exhibit significantly reduced DCP density and FAZ area, alongside increased CMT and CCPA. Following vitrectomy with membrane peeling, CMT decreased progressively, DCP density demonstrated partial restoration, and vision improved gradually. Preoperatively, smaller CMT larger DCP, and FAZ were associated with more favorable surgical outcomes; postoperatively, smaller ICP and SCP densities—combined with a larger FAZ—also correlated with better functional recovery.

ObjectiveTo investigate the mechanisms by which Mahuang Lianqiao Chixiaodoutang （MLC） improves obesity-type polycystic ovary syndrome （PCOS） through the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway. MethodsThirty-six female Sprague-Dawley （SD） rats were randomly divided into a blank control group （Con） and an obesity-type PCOS model preparation group. The model was induced by gavage with letrozole （1 mg·kg^-1） combined with a high-fat diet （HFD）. After model establishment， the obesity-type PCOS model preparation group was further divided into the model group （Mod， normal saline）， metformin group （Met， 0.3 g·kg^-1）， low-dose MLC group （MLC-L， 4.3 g·kg^-1）， medium-dose MLC group （MLC-M， 8.6 g·kg^-1）， and high-dose MLC group （MLC-H， 17.2 g·kg^-1）. Active components of MLC and targets of obesity-type PCOS were screened from databases， a protein-protein interaction （PPI） network was constructed， and gene ontology（GO）and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis was performed. The gut microbiota structure was analyzed based on 16S rRNA sequencing and correlated with network pharmacology pathways. Body weight and estrous cycle were dynamically monitored. Ovarian morphology was observed by hematoxylin-eosin （HE） staining. Cell apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling （TUNEL）. Enzyme-linked immunosorbent assay （ELISA） was used to detect levels of follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， anti-Müllerian hormone （AMH）， testosterone （T）， and estradiol （E₂）. Western blot was used to detect the protein expression levels of phosphorylated PI3K/PI3K （p-PI3K/PI3K）， phosphorylated Akt/Akt （p-Akt/Akt）， B-cell lymphoma-2 （Bcl-2）， and Bcl-2-associated X protein （Bax）. ResultsNetwork pharmacology screening identified 124 active components of MLC and 408 overlapping targets between the herbal formula and the disease. Core targets such as Akt1 and Bcl-2 were revealed. As indicated by 16S rRNA sequencing， the abundances of Lachnospiraceae， Lachnoclostridium， and Dorea were increased in the MLC groups （P<0.05）， while the abundance of Veillonella was decreased （P<0.05）. KEGG correlation analysis integrating network pharmacology and gut microbiota data showed significant enrichment of the PI3K/Akt signaling pathway. Animal experiments showed that， compared with the Mod group， body weight decreased to normal levels in the Met， MLC-M， and MLC-H groups. The estrous cycle became regular. The number of corpora lutea increased and cystic follicles decreased. Serum levels of T， FSH， and LH/FSH were reduced （P<0.05， P<0.01）， while the E₂ level was increased （P<0.01）. Ovarian cell apoptosis was reduced （P<0.01）， and the protein expression levels of p-PI3K/PI3K， p-Akt/Akt， and Bcl-2 in ovarian tissue were significantly increased， whereas Bax protein expression was significantly decreased （P<0.05， P<0.01）. ConclusionMLC can regulate gut microbiota structure， effectively improve ovarian pathology in rats with obesity-type PCOS， and inhibit ovarian granulosa cell apoptosis. The mechanism may be associated with upregulation of the PI3K/Akt signaling pathway.

ObjectiveTo investigate the mechanisms by which Mahuang Lianqiao Chixiaodoutang （MLC） improves obesity-type polycystic ovary syndrome （PCOS） through the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway. MethodsThirty-six female Sprague-Dawley （SD） rats were randomly divided into a blank control group （Con） and an obesity-type PCOS model preparation group. The model was induced by gavage with letrozole （1 mg·kg^-1） combined with a high-fat diet （HFD）. After model establishment， the obesity-type PCOS model preparation group was further divided into the model group （Mod， normal saline）， metformin group （Met， 0.3 g·kg^-1）， low-dose MLC group （MLC-L， 4.3 g·kg^-1）， medium-dose MLC group （MLC-M， 8.6 g·kg^-1）， and high-dose MLC group （MLC-H， 17.2 g·kg^-1）. Active components of MLC and targets of obesity-type PCOS were screened from databases， a protein-protein interaction （PPI） network was constructed， and gene ontology（GO）and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis was performed. The gut microbiota structure was analyzed based on 16S rRNA sequencing and correlated with network pharmacology pathways. Body weight and estrous cycle were dynamically monitored. Ovarian morphology was observed by hematoxylin-eosin （HE） staining. Cell apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling （TUNEL）. Enzyme-linked immunosorbent assay （ELISA） was used to detect levels of follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， anti-Müllerian hormone （AMH）， testosterone （T）， and estradiol （E₂）. Western blot was used to detect the protein expression levels of phosphorylated PI3K/PI3K （p-PI3K/PI3K）， phosphorylated Akt/Akt （p-Akt/Akt）， B-cell lymphoma-2 （Bcl-2）， and Bcl-2-associated X protein （Bax）. ResultsNetwork pharmacology screening identified 124 active components of MLC and 408 overlapping targets between the herbal formula and the disease. Core targets such as Akt1 and Bcl-2 were revealed. As indicated by 16S rRNA sequencing， the abundances of Lachnospiraceae， Lachnoclostridium， and Dorea were increased in the MLC groups （P<0.05）， while the abundance of Veillonella was decreased （P<0.05）. KEGG correlation analysis integrating network pharmacology and gut microbiota data showed significant enrichment of the PI3K/Akt signaling pathway. Animal experiments showed that， compared with the Mod group， body weight decreased to normal levels in the Met， MLC-M， and MLC-H groups. The estrous cycle became regular. The number of corpora lutea increased and cystic follicles decreased. Serum levels of T， FSH， and LH/FSH were reduced （P<0.05， P<0.01）， while the E₂ level was increased （P<0.01）. Ovarian cell apoptosis was reduced （P<0.01）， and the protein expression levels of p-PI3K/PI3K， p-Akt/Akt， and Bcl-2 in ovarian tissue were significantly increased， whereas Bax protein expression was significantly decreased （P<0.05， P<0.01）. ConclusionMLC can regulate gut microbiota structure， effectively improve ovarian pathology in rats with obesity-type PCOS， and inhibit ovarian granulosa cell apoptosis. The mechanism may be associated with upregulation of the PI3K/Akt signaling pathway.

Objective:To investigate the efficacy of combined sufentanil and remifentanil in pediatric ear, nose, and throat surgeries.Methods:This study used a prospective study design. A total of 110 pediatric children who underwent elective ear, nose, and throat surgery at Xi'an Children's Hospital from January 2022 to December 2023 were included in this study. The patients were randomly divided into a control group ( n = 55) and an observation group ( n = 55) using a random number table method. In the control group, only sufentanil was used for general anesthesia, while the observation group received both sufentanil and remifentanil during the anesthesia process. The changes in average arterial pressure and heart rate were compared between the two groups at five time points: T1 (before anesthesia induction), T2 (during tracheal intubation), T3 (at the start of surgery), T4 (5 min after the start of surgery), and T5 (immediately after surgery). Additionally, the recovery time for spontaneous breathing, the time to open eyes, extubation time, and adverse reactions were compared between the two groups. Ramsay sedation scores were compared between the two groups at three time points: T6 (5 min after extubation), T7 (15 min after extubation), and T8 (30 min after extubation). Pain Visual Analog Score was compared between the two groups at T8 (30 min after extubation), T9 (60 min after extubation), and T10 (90 min after extubation). Results:The differences in average arterial pressure and heart rate between the two groups at time points T1-T5, as well as Ramsay sedation scores at T6-T8 and Visual Analog Score scores at T8-T10, were all statistically significant ( F = 152.93, 2 718.29, 2 347.47, 751.77, all P < 0.05). In the observation group, the recovery time for spontaneous breathing [(5.37 ± 2.18) min vs. (6.74 ± 2.42) min], the time to open eyes [(9.03 ± 2.02) min vs. (10.84 ± 3.11) min], and extubation time [(13.22 ± 4.22) min vs. (16.47 ± 5.14) min] were significantly shorter in the observation group than in the control group ( t = 3.11, 3.62, 3.62, all P < 0.001). The incidence of adverse reactions was significantly lower in the observation group than in the control group [3.64% (2/55) vs. 16.36% (9/55), χ2 = 4.94, P < 0.05]. Conclusions:Both sufentanil alone and in combination with remifentanil yield effective anesthesia outcomes in pediatric ear, nose, and throat surgeries. However, the combination of sufentanil and remifentanil significantly shortens the recovery time for spontaneous breathing, the time to open eyes, and extubation time. This combined approach also lowers the incidence of adverse reactions, improves surgical outcomes, and promotes postoperative recovery of children.

Objective:To investigate the effects of wheat-grain moxibustion at the Guanyuan point on testosterone(T)synthe-sis and the hypothalamic-pituitary-gonadal(HPG)axis in naturally aged mice.Methods:We fed 40 twelve-month-old SPF male C57BL/6J mice with a normal diet for 3 months,randomized them into a moxibustion and an aged group of an equal number,and se-lected 7 four-month-old ones as young controls.We treated the animals of the moxibustion group by wheat-grain moxibustion at the Guanyuan point,once 5 moxibustion sticks,qd,5 times a week,and fed those of the aged group normally,all for 12 weeks.After treatment,we obtained the testicular index of the mice,observed the histomorphology of the testis tissue by HE staining,measured the contents of T in the testis,gonadotropin-releasing hormone(GnRH)in the hypothalamus and total T(tT),free T(fT),luteinizing hormone(LH)and follicle-stimulating hormone(FSH)in the serum by ELISA,and determined the expressions of silence information regulator-1(SIRT1),P53,glutathione peroxidase(GPX4)and cholesterol side-chain?cleavage enzym e(CYP11A1)in the testis by Western blot.Results:Compared with the young controls,the mice in the aged group showed obviously losing and dull hair,energy declination,loose structure of the spermatogenic tubule with different degrees of cell loss and rupture,reduced testicular index,and ev-ident aging phenotype.In comparison with the aged mice,the animals of the moxibustion group were fairly energetic and exhibited dis-tinct structure of the spermatogenic tubules,orderly arranged and highly differentiated cells at all levels,significantly increased T lev-el,up-regulated expressions of SIRT1,GPX4 and CYP11 A1,and down-regulated expression of P53 in testis tissue,and elevated levels of GnRH,FSH,LH,tT and fT in the HPG axis.Conclusion:Wheat-grain moxibustion at the Guanyuan point protects testosterone synthesis in the testis tissue of naturally aged mice,promotes negative feedback regulation of the HPG axis,and improves low testoster-one.

Objective:To investigate the efficacy of combined sufentanil and remifentanil in pediatric ear, nose, and throat surgeries.Methods:This study used a prospective study design. A total of 110 pediatric children who underwent elective ear, nose, and throat surgery at Xi'an Children's Hospital from January 2022 to December 2023 were included in this study. The patients were randomly divided into a control group ( n = 55) and an observation group ( n = 55) using a random number table method. In the control group, only sufentanil was used for general anesthesia, while the observation group received both sufentanil and remifentanil during the anesthesia process. The changes in average arterial pressure and heart rate were compared between the two groups at five time points: T1 (before anesthesia induction), T2 (during tracheal intubation), T3 (at the start of surgery), T4 (5 min after the start of surgery), and T5 (immediately after surgery). Additionally, the recovery time for spontaneous breathing, the time to open eyes, extubation time, and adverse reactions were compared between the two groups. Ramsay sedation scores were compared between the two groups at three time points: T6 (5 min after extubation), T7 (15 min after extubation), and T8 (30 min after extubation). Pain Visual Analog Score was compared between the two groups at T8 (30 min after extubation), T9 (60 min after extubation), and T10 (90 min after extubation). Results:The differences in average arterial pressure and heart rate between the two groups at time points T1-T5, as well as Ramsay sedation scores at T6-T8 and Visual Analog Score scores at T8-T10, were all statistically significant ( F = 152.93, 2 718.29, 2 347.47, 751.77, all P < 0.05). In the observation group, the recovery time for spontaneous breathing [(5.37 ± 2.18) min vs. (6.74 ± 2.42) min], the time to open eyes [(9.03 ± 2.02) min vs. (10.84 ± 3.11) min], and extubation time [(13.22 ± 4.22) min vs. (16.47 ± 5.14) min] were significantly shorter in the observation group than in the control group ( t = 3.11, 3.62, 3.62, all P < 0.001). The incidence of adverse reactions was significantly lower in the observation group than in the control group [3.64% (2/55) vs. 16.36% (9/55), χ2 = 4.94, P < 0.05]. Conclusions:Both sufentanil alone and in combination with remifentanil yield effective anesthesia outcomes in pediatric ear, nose, and throat surgeries. However, the combination of sufentanil and remifentanil significantly shortens the recovery time for spontaneous breathing, the time to open eyes, and extubation time. This combined approach also lowers the incidence of adverse reactions, improves surgical outcomes, and promotes postoperative recovery of children.

Jianghuanglian is one of the representative processed products of Coptidis Rhizoma for treating cold syndrome with drugs of heat nature， and ginger is used to restrict the bitter cold of Coptidis Rhizoma， which can be traced back to Bojifang， and it is suitable for stagnation of damp-heat in middle-jiao， cold-heat mutual knots and other symptoms. Jianghuanglian retains the alkaloids， phenylpropanoids and flavonoids of Coptidis Rhizoma， and also introduces gingerol components such as 6-gingerol in ginger， which has pharmacological activities such as anti-inflammatory， antibacterial， anti-tumor， and improving gastrointestinal function. The 2020 edition of Chinese Pharmacopoeia and many local processing specifications have included the traditional processing process and quality standards of Jianghuanglian， but the specific process parameters and quality standards are incomplete， which limits the production and clinical application of this processed product. By summarizing the processing history， process research， quality evaluation， pharmacodynamic and medicinal property changes and application of Jianghuanglian in the past 20 years， there are differences in the processing methods and standards in various provinces and cities， which are mainly reflected in the preparation method， dosage， processing process and quantitative standards of ginger juice. In addition， there are also certain differences in the changes of the main components of Jianghuanglian prepared from ginger or dried ginger， as well as their efficacy and medicinal properties. The research on the processing process of Jianghuanglian plays an important role in improving its quality standards， and this review can provide a reference for improving the quality evaluation system of Jianghuanglian.

Diabetic kidney disease(DKD)is a microvascular complication of diabetes mellitus with a complex pathogenesis.Recent studies have revealed that autophagy and ferroptosis,as two forms of programmed cell death,exhibit dynamic interactions in DKD:autophagy maintains homeostasis by eliminating damaged organelles,while ferroptosis is driven by iron-dependent lipid peroxidation.Imbalance between the two exacerbates renal injury.This review systematically summarizes the signaling pathways and key regulatory factors related to autophagy and ferroptosis,as well as their interaction mechanisms[such as nuclear receptor coactivator 4(NCOA4)-mediated ferritinophagy,clock autophagy,and lipid autophagy].It further elaborates the molecular network by which these processes synergistically regulate DKD progression.Additionally,the potential of modern pharmaceuticals and active components of traditional Chinese medicine to improve kidney injury by targeting autophagy and ferroptosis is discussed,proposing that targeting their cross-talk pathways may provide novel therapeutic strategies for DKD,aiming to lay a theoretical foundation for the development of targeted intervention strategies and precision therapeutic regimens.

Objective To investigate the impact of myeloid cell-specific knockout of the granulocyte colony-stimulating factor receptor(G-CSFR)on the progression of acute radiation pneumonitis.Methods Myeloid cell-specific G-CSFR knockout(G-CSFR-/-,Lyz2-cre)mice were constructed.G-CSFR-/-,Lyz2-cre and C57BL/6N mice underwent a single whole-body irradiation with 6.5 Gy of 60Co γ-rays to establish a model of radiation injury.The lung function of mice was assessed using a mouse lung function test system at 3,7 and 14-days post γ-ray irradiation.Pathological changes in the lung tissue were analyzed via hematoxylin and eosin(HE)staining of paraffin sections.Tumor necrosis factor-α(TNF-α)and interleukin-10(IL-10)levels were measured via radioimmunoassay.IL-8 and its receptor CXCR2 were quantified using enzyme-linked immunosorbent assay(ELISA).The infiltration of neutrophils in lung tissue was evaluated by immunohistochemical detection of myeloperoxidase.Results At 3-,7-and 14-days post-irradiation with 6.5 Gy of 60Co γ-rays,there were no significant differences observed in lung function or interstitial inflammatory lesions between G-CSFR-/-,Lyz2-cre mice and C57BL/6N mice.However,the infiltration of neutrophils in lung tissue of G-CSFR-/-,Lyz2-cre mice was significantly reduced(P＜0.01),and the levels of IL-8,CXCR2 and TNF-α in lung tissues were markedly lower than in C57BL/6N mice(P＜0.05).Conclusion The myeloid cell-specific knockout of G-CSFR can effectively diminish neutrophil infiltration as well as inflammatory cytokine levels in lung tissues following radiation exposure.

Objective To analyze the changes of intestinal microbiota in patients with nonalcoholic fatty liver disease(NAFLD)and healthy controls so as to explore the relationship between intestinal microbiota and NAFLD.Methods A total of 353 samples from the National Center for Biotechnology Information were included,including 110 healthy controls and 243 NAFLD patients(127 NASH and 116 NAFLD).Macrogenome sequencing data were extracted to obtain data on intergroup flora diversity changes and analyze the potential correlation between alterations in gut microbes and NAFLD.Results Alpha diversity analysis showed no significant differences in Invsimpson index(P=0.57)or Simpson index(P=0.57)between NAFLD patients and healthy controls,while there was a trend of decreasing Shannon index(P=0.084),but with no significant difference.β-diversity analysis showed significant differences between the two groups(P=0.002).Species composition analysis showed that at the genus level,NAFLD patients and healthy controls had the same species types,with Bacteroidetes and Firmicutes being the dominant phyla in both groups.However,compared to Control group,NAFLD group had significantly lower Firmicutes,Synergistetes,and Candidatus_Melainabacteria.At the species level,there were significant differences between NAFLD group and Control group for 10 bacterial species,including Bacteroides_uniformis and Faecalbacterium_prausnitzil.Intergroup difference analysis showed that Phocaeicola dorei,Parabacteroides_distasonis,Bilophila_wadsworthia,and Dysosmobacter_welbionis were significantly enriched in NAFLD patients(LDA score＞2.0,P＜0.05),while Prevotella_stercorea,Faecalibacterium prausnitzii,and others were negatively associated with NAFLD.A disease detection model was constructed based on metagenomic data,and 26 intestinal microorganisms related to NAFLD were selected,including Pyramidobacter piscolens and Citrobacter freundii,etc.The diagnostic accuracy of NAFLD was judged by ROC curve discriminant model,and the AUC of the ROC curve was 0.743 8,indicating that the model has a certain accuracy in diagnosing NAFLD.Conclusion This study revealed differences in gut microbial diversity between NAFLD patients and healthy controls and identified key bacterial groups associated with NAFLD.In addition,the disease detection model constructed based on metagenomic data provides a new method and idea for the diagnosis of NAFLD,which is conducive to further study of the disease and the early diagnosis and treatment of clinical patients.