To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

ObjectiveTo investigate the mechanism of Forsythiae Fructus-Lonicerae Japonicae Flos（FF） in the treatment of acute lung injury（ALI） by investigating the effects of FF on serum metabolomics of rats with ALI. MethodsThirty male SD rats were acclimated for 1 week， and 6 rats were randomly selected as the blank group. The other 24 rats were injected with lipopolysaccharide（LPS） solution by tracheal drip to establish an ALI model. After successful model establishment， the rats were randomly divided into the model group， the FF low-dose group（3.0 g·kg^-1）， the FF high-dose group（6.0 g·kg^-1）， and the dexamethasone group（5 mg·kg^-1）， with six rats in each group. The FF low- and high-dose groups and the dexamethasone group were received daily oral administration of the corresponding drug solution， and the blank group and the model group were gavaged with an equal amount of saline， treatment was administered continuously for 3 d. The pathological conditions of rat lung tissues were evaluated by hematoxylin-eosin（HE） staining， wet/dry mass ratio（W/D） of the lung tissues， and protein concentration in rat bronchoalveolar lavage fluid（BALF）. Metabolomic analysis of rat serum was performed by ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS）， combined with multivariate statistical analysis， the potential biomarkers of FF in treating ALI were screened by variable importance in the projection（VIP） value>1， P<0.05 from t-test， and log₂fold change（FC）>1 or log₂FC<-1. Kyoto Encyclopedia of Genes and Genomes（KEGG） database combined with MetaboAnalyst were used for pathway analysis of the screened differential metabolites. The protein expression levels of sphingosine-1-phosphate（S1P）， phosphatidylinositol 3-kinase（PI3K）， protein kinase B1（Akt1）， and phosphorylated Akt1（p-Akt1） were examined by Western bolt. The expression levels of interleukin（IL）-6， IL-1β， and tumor necrosis factor（TNF）-α in BALF were detected by enzyme-linked immunosorbent assay（ELISA）. ResultsCompared with the blank group， rats in the model group showed ALI pathological features such as alveolar lumen dilatation， interstitial hemorrhage and massive inflammatory cell infiltration， and the protein concentration in BALF and W/D of the lung tissues were significantly elevated（P<0.01）. Compared with the model group， the low- and high-dose groups of FF as well as the dexamethasone group exhibited reduced pulmonary bronchial hemorrhage in rats， and the protein concentration in BALF and W/D were significantly decreased（P<0.05）， and the lung injury was significantly alleviated. Analysis of rat serum metabolomics revealed that FF downregulated 38 biomarkers. Pathway enrichment analysis showed that FF primarily exerted therapeutic effects through 7 key metabolic pathways， including arginine biosynthesis， sphingomyelin metabolism， alanine， aspartate and glutamate metabolism， taurine and hypotaurine metabolism， α-linolenic acid metabolism， niacin and nicotinamide metabolism， and retinol metabolism. The results of Western bolt and ELISA showed that， compared with the blank group， the model group exhibited significantly elevated expression levels of S1P， PI3K， Akt1 and p-Akt1 proteins in the lung tissues， as well as increased expression levels of IL-6， IL-1β and TNF-α in BALF（P<0.01）. Compared with the model group， the expression levels of the aforementioned indicators were significantly downregulated in the low- and high-dose FF groups as well as the dexamethasone group（P<0.05， P<0.01）. ConclusionFF may play a role in ALI by regulating amino acid metabolism and lipid metabolism， and its mechanism may be related to the inhibition of S1P/PI3K/Akt1 signaling pathway to attenuate the inflammatory response caused by ALI.

Objective:To establish fingerprints of Faeces Bombycis and simultaneously determine the content of four amino acids; To evaluate the quality of Faeces Bombycis from different regions. The fingerprint of Faeces Bombycis was established and the contents of 4 amino acids were determined.Methods:Kromasil 100-5 C18 (4.6 mm×250 mm, 5 μm) column was used for phenyl isothiocyanate (PITC) pre-column derivation-high performance liquid chromatography with acetonitrile-0.1 mol/L sodium acetate solution (pH adjusted to 6.5 with acetic acid) (7:93) mixed solution, and acetonitrile-water (4:1) mixed solution were mobile phase for gradient elution. The flow rate was 1.0 ml/min; the column temperature was 35 ℃; the detection wavelength was 254 nm; the injection amount was 5 μl. The fingerprints of 17 batches of Faeces Bombycis were established, the common peaks were identified by comparison of reference materials, and the similarity evaluation and principal component analysis (PCA) were carried out. The contents of glycine, alanine, proline and phenylalanine were determined simultaneously.Results:A total of 12 common peaks were identified from the fingerprints of Faeces Bombycis, and 12 amino acids were identified. The similarity of 17 batches of samples was greater than 0.95. PCA analysis showed that the regional difference of the quality of Faeces Bombycis was not significant. Faeces Bombycis produced in Qujing city in Yunnan Province had the highest total contents of 4 amino acids.Conclusion:The method has good repeatability and can provide reference for the quality evaluation and standard improvement of Faeces Bombycis.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.

ObjectiveTo investigate the relationship of physical activity (PA) and cognitive function to sleep quality in older adults with cognitive impairment based on resting electroencephalogram (EEG), and to explore the mediating role of specific EEG markers in the relationship between PA and sleep quality. MethodsFrom March to May, 2024, 137 older adults were recruited from Chenfu Jiayuan and Qiangwei Jiuli in Songjiang district, and Luyan communities in Jinshan district, Shanghai. The assessments included Montreal Cognitive Assessment (MoCA), International Physical Activity Questionnaire-Short Form (IPAQ-SF) and Pittsburgh Sleep Quality Index (PSQI), along with a five-minute EEG recording. ResultsThere was significant difference in sleep quality among older adults with different levels of cognitive impairment (t = -7.400, P < 0.001). The PSQI total score was negatively correlated with MoCA scores (r = -0.412, P < 0.001) and total physical activity level (PAL) (r = -0.363, P < 0.001). The θ power in the frontal areas (F3, F4) was significantly correlated with both PSQI scores and PAL (P < 0.01). The θ power in F3 + F4 exhibited a significant partial (effect size = -0.0004, 95%CI -0.0007 to -0.0002) mediating effect between PA and sleep quality in older adults with cognitive impairment. ConclusionOlder adults with more severe cognitive impairment tend to have poorer sleep quality, whereas higher PAL is associated with better sleep quality. PA can indirectly influence sleep quality in older adults with cognitive impairment by affecting θ power (F3 + F4).

Objective:To explore the characteristics of tongue microbiota in patients with pancreatic neuroendocrine neoplasms (pNENs).Methods:The tongue coating microbiota of 15 pathologically diagnosed pNENs patients from Nanjing First Hospital between November 2019 and July 2020 were selected, and 15 healthy volunteers were recruited as the healthy control group. Oral pharyngeal swab was used to scrape the tongue coating, and DNA extraction and detection of the tongue coating samples from two groups were performed, 16S rRNA gene high-volume sequencing was applied to analyze the differences on the microbiome. The α and β diversity differences were tested by Chao1 index, Shannon index and principal component analysis, respectively. The inter-group analysis of variances was used to compare the species composition of tongue coating microbiota at the phylum, genus, and species levels between two groups. Differences in dominant bacterial genera between two groups were analyzed by using linear discriminant analysis (LEfSe).Results:Compared with the healthy control group, the types and quantities of tongue coating microbiota in pNENs patients were similar, but the structural composition was significantly different. At the phylum level, Proteobacteria, Bacteroides, Firmicutes, Fusobacteria and Actinobacteria were mainly present in both two groups, but Firmicutes and Actinobacteria were relatively more in pNENs patients compared with healthy groupy with more Bacteroides. The dominant genera of tongue coating microbiota in pNENs patients and healthy individuals included Haemophilus, Neisseria, and Prevotella_7, Streptococcus, Fusobacterium, Alloprevotella and Veillonella. The relative abundance of Fusobacterium, Alloprevotella, Prevotella and Aggregatibacter in the healthy control group's tongue coating microbiota was higher, while Veillonella had a higher relative abundance in the tongue coating microbiota of pNENs patients. LEfSe results showed that the dominant microflora were Actinobacteria at phylum level and Roseburia at genera level in pNENs patients, which were Aggregatibacter at genera level in healthy group. Conclusions:The distribution of tongue coating microbiota in pNENs patients are different from those in healthy people. The increase in abundance of Actinobacteria and Roseburia, as well as the decrease in abundance of Aggregatibacter, may have potential implications for the diagnosis of pNENs.

Nasopharyngeal carcinoma is one of the most common head and neck tumors. At present, intensity modulated radiation therapy (IMRT) is the main radical treatment. In recent years, adaptive radiation therapy (ART) becomes the focus in the research field of precision radiotherapy. ART can reduce the target conformal and dose changes and increase the dose of exposed organs caused by factors such as weight loss, positioning error, systematic error, and anatomical changes of lesions and organs at risk, thus improving the effectiveness and safety of intensity modulated radiotherapy. This article focuses on and summarizes the recent progress in the application of ART in nasopharyngeal carcinoma, and puts forward the possible research direction in the future.

Objective:To explore the impact of tissue inhomogeneity correction on the accuracy of dose calculations in brachytherapy of cervical carcinoma by comparing the results of Monte Carlo (MC) dose simulation with those (TG43 algorithm) of treatment planning system (TPS).Methods:Firstly, the 192Ir source was modeled by using a MC code specially designed for brachytherapy, called egs_brachy. The accuracy of this model was verified by comparing it with the published data. Then, 8 brachytherapy plans of cervical carcinoma were selected which completed treatment at Sun Yat-sen University Cancer Center from January 2022 to May 2023, and their CT image data and treatment parameters were exported. Relevant plan information such as the source dwell positions and their corresponding dwell times were reconstructed on the patient's individualized CT images using a self-developed program. The MC dose distributions were calculated for each case and compared with the TPS calculations. When the anterior wall of the rectum was filled with gas, the differences between MC simulation and TPS calculation were compared. Additionally, 5 different calculation ranges were set for MC simulation, and the MC simulation results of different calculation ranges were compared with the TPS's, combining with the time of MC simulation, a reasonable MC calculation range was comfirmed. Then, the scipy.stats library of Python was utilized to perform independent sample t-test on dosimetric comparison results, including D 90% of high risk clinical target volume (HR-CTV) and D max, D mean, and D 2 cm3 of organs at risk (OAR). Results:The comparison between MC calculations and TPS results showed that the CTV's D 90%, the bladder's D mean and the small intestine's D mean were all within ± 1%, except for the D max difference of approximately 3% on the anterior wall of the rectum. The 2%/2 mm gamma pass rates were all>98%. When anterior wall of the rectum filled with gas, compared with MC, TPS overestimated the anterior wall of the rectum's D 2 cm3 and D mean by approximately 6.06% ( t=-6.80, P=0.002) and 5.35% ( t=-6.57, P=0.003), respectively. When the dose calculation range of MC was consistent with that of TPS, the MC calculation result underestimated the dose distribution in water by approximately 4%. When extending the MC dose calculation range by 2 cm beyond the TPS calculation range, the dose difference between MC and TPS in homogeneous water was approximately 1%, and the calculation time was saved by at least 8 h compared to MC dose calculation based on the whole CT. Conclusion:The existing TPS TG43 algorithm can ensure that the dose calculation of cervical carcinoma meets the basic accuracy requirements of clinical practice, but tissue inhomogeneity correction is recommended to improve the accuracy of dose calculation whenever possible.

Objective:To investigate the effects of targeted regulation of SMAD9 expression by bone morphogenetic protein 4 (BMP4) on Müller cell migration, reactive oxygen species (ROS) generation and vascular endothelial growth factor (VEGF) expression.Methods:Müller cells cultured in vitro were divided into normal control group, BMP4 group, BMP4+ no-load plasmid group (BMP4+NC group) and BMP4+SMAD9 small interference plasmid group (BMP4+siSMAD9). Cells in BMP4 group, BMP4+NC group and BMP4+siSMAD9 group were induced by adding 100 ng/ml BMP4 into cell medium for 24 h. Subsequently, BMP4+NC group was transfected with empty plasmid. BMP4+siSMAD9 group was transfected with SMAD9 small interference plasmid for 48 h. The effect of BMP4 on Müller cell migration was determined by cell scratch test. The effect of BMP4 on the production of ROS in Müller cells was detected by flow cytometry. Western blots and real-time quantitative fluorescence polymerase chain reaction (qPCR) were used to detect the relative mRNA expression levels of glutamine synthetase (GS) and glial fibrinoacidic protein (GFAP) in Müller cells. VEGF expression in Müller cells was detected by immunofluorescence. One-way analysis of variance was used to compare groups.Results:The results of cell scratch test showed that the cell mobility of BMP4+siSMAD9 group was significantly lower than that of BMP4 and BMP4+NC group, and the difference was statistically significant ( F=68.319, P<0.001). Flow cytomethods showed that the level of ROS in BMP4+siSMAD9 group was significantly lower than that in BMP4 and BMP4+NC group, and the difference was statistically significant ( F=52.158, P<0.001). Western blot and qPCR results showed that the protein levels of GS and GFAP ( F=42.715, 36.618) and mRNA relative expression levels ( F=45.164, 43.165) in BMP4+siSMAD9 group were significantly lower than those in BMP4 and BMP4+NC group. The difference was statistically significant ( P<0.01). The results of immunofluorescence detection showed that the intracellular VEGF fluorescence intensity in BMP4 group and BMP4+NC group was significantly higher than that in BMP4+siSMAD9 group, and the difference was statistically significant ( F=46.384, P<0.05). Conclusion:Targeted regulation of SMAD9 expression by BMP4 can up-regulate VEGF expression and promote the migration and ROS production of Müller cells.

Objective:To investigate the effect of Nodal protein on retinal neovascularization under hypoxia.Methods:In vivo animal experiment: 48 healthy C57BL/6J mice were randomly divided into normal group, oxygen-induced retinopathy (OIR) group, OIR+dimethyl sulfoxide (DMSO) group and OIR+SB431542 group, with 12 mice in each group. Retinal neovascularization was observed in mice at 17 days of age by retina flat mount. Counts exceeded the number of vascular endothelial nuclei in the retinal inner boundary membrane (ILM) by hematoxylin eosin staining. In vivo cell experiment: human retinal microvascular endothelial cells(hRMEC) were divided into normal group, hypoxia group, hypoxia+DMSO group and hypoxia +SB431542 group. The cell proliferation was detected by thiazolyl blue colorimetry (MTT). The effect of SB431542 on hRMEC lumen formation was detected by Matrigel three-dimensional in vitro molding method. Cell migration in hRMEC was detected by cell scratch assay. The Seahorse XFe96 Cell Energy Metabolism analyzer measured extracellular acidification rate (ECAR) of intracellular glycolysis, glycolysis reserve, and glycolysis capacity. One-way analysis of variance was used to compare groups.Results:In vivo animal experiment: compared with normal group, the neovascularization increased in OIR group ( t=41.621, P<0.001). Compared with OIR group, the number of vascular endothelial nuclei breaking through ILM in OIR+SB431542 group was significantly reduced, and the difference was statistically significant ( F=36.183, P<0.001). MTT test results showed that compared with normal group and hypoxia+SB431542 group, the cell proliferation of hypoxia group and hypoxia+DMSO group was significantly increased, and the difference was statistically significant ( F=39.316, P<0.01). The cell proliferation of hypoxia+SB431542 group was significantly lower than that of hypoxia+DMSO group, and the difference was statistically significant ( t=26.182, P<0.001). The number of intact lumen formation and migration cells in normal group, hypoxia group, hypoxia+DMSO group and hypoxia+SB431542 group were statistically significant ( F=34.513, 41.862; P<0.001, <0.01). Compared with the hypoxia+DMSO group, the number of intact lumen formation and migrating cells in the hypoxia+SB431542 group decreased significantly, and the differences were statistically significant ( t=44.723, 31.178; P<0.001,<0.01). The results of cell energy metabolism showed that compared with the hypoxia +DMSO group, the ECAR of intracellular glycolysis and glycolysis reserve in the hypoxia +SB431542 group was decreased, and the ECAR of glycolysis capacity was increased, with statistical significance ( t=26.175, 33.623, 37.276; P<0.05). Conclusion:SB431542 can inhibit the proliferation, migration and the ability to form lumens, reduce the level of glycolysis of hRMECs cells induced by hypoxia.