ObjectiveTo explore the clinical efficacy and mechanism of Bupi Qingfei prescription （BPQF） in treating stable bronchiectasis in the patients with syndromes of lung-spleen Qi deficiency and phlegm-heat accumulation in the lungs. MethodsA randomized， double-blind， placebo-controlled trial was conducted. Patients were randomized into BPQF and placebo control （PC） groups. On the basis of conventional Western medicine treatment， the BPQF granules and placebo were respectively administered at 10 g each time， twice a day， for a course of 24 weeks. The TCM symptom scores， Quality of Life Questionnaire for Bronchiectasis （QOL-B） scores， lung function indicators， T lymphocyte subsets， level of inflammatory factors in the sputum， level of neutrophil elastase （NE） in the sputum， and occurrence of adverse reactions were observed before and after treatment in the two groups. ResultsA total of 64 patients completed the study， encompassing 32 in the BPQF group and 32 in the PC group. After treatment， the BPQF group showed decreased TCM symptom scores （P<0.01）， increased QOL-B scores （P<0.01）， and declined levels of tumor necrosis factor （TNF）-α and NE （P<0.05， P<0.01）. The PC group showed decreased TCM symptom （except spleen deficiency） scores （P<0.01）， increased the QOL-B health cognition and respiratory symptom domain scores （P<0.05， P<0.01）， and a declined TNF-α level （P<0.01）. Moreover， the BPQF group had lower TCM symptom （except chest tightness） scores （P<0.05， P<0.01）， higher QOL-B （except treatment burden） scores （P<0.05， P<0.01）， and lower levels of interleukin-6 and TNF-α （P<0.05） than the PC group. Neither group showed serious adverse reactions during the treatment process. ConclusionBPQF can ameliorate the clinical symptoms of stable bronchiectasis patients who have lung-spleen Qi deficiency or phlegm-heat accumulation in the lungs by regulating the immune balance and inhibiting airway inflammatory responses.

Hepatitis B virus （HBV） exclusively infects liver parenchymal cells and forms covalently closed circular DNA （cccDNA） within their nuclei. HBV cccDNA serves as the essential template for viral gene transcription， the sole source of progeny virus production， and the key driver of viral antigen expression， and it is the molecular basis for the persistence of HBV infection. Therefore， elimination and/or functional silencing of cccDNA is the key to eradicate chronic HBV infection. This article discusses the critical scientific issues that need to be solved during elimination of the harm of HBV infection from the perspectives of the synthesis， transcription， and clearance of cccDNA， as well as the impact of nonparenchymal cells on cccDNA， in order to provide a reference for eradicating HBV infection in the future.

Objective To investigate the regulatory mechanism of transforming growth factor-β1 (TGF-β1) in different types of mitral valvular disease (MVD) with atrial fibrillation (AF). Methods From August 2011 to August 2012, patients with moderate to severe MVD accompanied by AF who required mitral valve replacement at the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, were included. Based on echocardiographic results, patients were divided into two groups: a mitral regurgitation (MR) with AF (MR-AF) group and a mitral stenosis (MS) with AF (MS-AF) group. Left atrial tissue samples were collected during surgery. Techniques such as enzyme-linked immunosorbent assay, real-time fluorescence quantitative polymerase chain reaction, immunohistochemistry, and Western blotting were used to detect key molecules in the TGF-β1/JNK pathway. Results Sixteen patients were enrolled. There were 8 patients in the MR-AF group, including 5 males and 3 females, with an average age of (41.38±11.19) years; and 8 patients in the MS-AF group, including 6 males and 2 females, with an average age of (43.12±5.30) years. The left atrial volume load was higher in MR-AF patients, while the left atrial pressure load was higher in MS-AF patients. In MS-AF patients, the relative expression levels of MAPK9, JUN, CASP3, BAX, and BCL2 mRNA in left atrial tissues were significantly upregulated. The serum TGF-β1 protein level and the relative expression levels of p-JNK, p-c-Jun, and Caspase-3 proteins in the left atrial tissues of the MR-AF group were higher. Myocardial cell damage was more severe in the MS-AF group, and the protein expression level of Bcl-2 was higher. Conclusion Different MVD have distinct hemodynamic characteristics. The myocardium of the left atrium in MR-AF patients is more prone to apoptosis, possibly through the activation of the TGF-β1/JNK signaling pathway.

Objective To investigate the prognostic value of lectin galactoside binding soluble 3 binding protein(LGALS3BP)and growth differentiation factor-15(GDF-15)in patients with severe acute pancreatitis(SAP).Methods Ninety patients with SAP(SAP group)and 90 patients with mild pancreatitis(MAP)and moderately severe acute pancreatitis(MSAP)(non-SAP group)who attended the First Affiliated Hospital of Xi'an Medical College from January 2021 to January 2024 were foresight selected.The SAP group was separated into a good group(47 cases)and a bad group(43 cases)according to prognosis.Clinical data and relevant testing indicators were collected from the researchers.Compare the levels of serum LGALS3BP and GDF-15 in the SAP group and the non-SAP group;conduct Pearson correlation analysis;perform multivariate Logistic analysis to identify the influencing factors for the prognosis of SAP patients;and use ROC curve analysis to evaluate the value of serum LGALS3 BP and GDF-15 in predicting the prognosis of SAP patients.Results Compared with the non-SAP group group,the serum LGALS3BP and GDF-15 levels in the SAP group were greatly increased(65.26 ng/ml vs.118.63 ng/ml,1763.46 ng/ml vs.2534.83 pg/ml,P＜0.05).There was a positive correlation between serum LGALS3BP and GDF-15(r=0.479,P＜0.05).The expression levels of LGALS3BP and GDF-15 were lower in SAP patients at 48 h and 72 h after admission than at 24 h after admission,and the expression levels of LGALS3BP and GDF-15 were lower in SAP patients at 72 h after admission than at 48 h after admission(P＜0.05).Compared with the poor group,the serum levels of LGALS3BP and GDF-15 in the good group were greatly reduced(135.13 ng/ml vs.103.53 ng/ml,2879.63 pg/ml vs.2219.37 pg/ml,P＜0.05).Compared with the poor group,the C-reactive protein and BISAP scores of SAP patients in the good group were greatly reduced(P＜0.05).LGALS3BP and GDF-15 were risk factors affecting the prognosis of SAP(P＜0.05).The AUC of serum LGALS3BP for predicting the prognosis of SAP patients was 0.897,with sensitivity and specificity of 81.40％and 93.62％,respectively.The AUC of serum GDF-15 in predicting the prognosis of SAP patients was 0.897,with sensitivity and specificity of 76.74％and 93.62％,respectively.The AUC for predicting the prognostic effect in SAP patients with serum LGALS3BP and GDF-15 combination was 0.974,with sensitivity and specificity of 95.35％and 89.36％,respectively.The Zcombination-LGALS3BP and Zcombination-GDF-15 was 2.194 and 2.227,respectively,with P＜0.05.Conclusion Serum LGALS3BP and GDF-15 expression levels are elevated in SAP patients and have a poor prognosis SAP patients have higher serum LGALS3BP and GDF-15 expression levels.Elevated serum LGALS3BP and GDF-15 are detrimental to patient prognosis,and the combination of the two may be used in the future for prognostic assessment of patients with SAP.

Objective To explore and analyze the clinical application effect of thymosin α1 combined with folfox regimen in the adjuvant treatment of patients after transabdominal radical resection of rectal cancer(RC).Methods A total of 102 patients with RC in the hospital were included from January 2020 to January 2024,and were randomly and evenly classified into two groups by adopting random number table method.The conventional group received folfox regimen after radical resection,whereas the study group was added with thymosin α1.The levels of tumor-related factors,changes of immune function indicators,treatment safety,recurrence and metastasis,and tumor-related mortality were observed in the two groups after treatment.Results Compared with before treatment,the levels of carcinoembryonic antigen(CEA),hypoxia-inducible factor-1α(HIF-1α),matrix metalloproteinase-9(MMP-9)and vascular endothelial growth factor(VEGF)in the two groups were significantly decreased,and the levels in the study group were significantly lower than those in the conventional group(P<0.05).After Bonferroni correction,CEA and MMP-9 were statistically different between groups(P<0.010).The CD83+,CD4+/CD8+and NK cell activity were significantly enhanced in the two groups compared to before treatment,and the above indicators were significantly higher in the study group(P<0.05).After Bonferroni correction,there were statistical differences in CD83+,CD4+/CD8+and NK cell activity between groups(P<0.010).In terms of treatment safety,the total incidence rate of toxic and side effects in the study group was 23.53%,which was significantly lower than 43.14%in the conventional group(P<0.05).Logistic regression(stepwise forward method)analysis showed that nerve invasion,vascular tumor thrombus and folfox regimen were risk factors of tumor recurrence and metastasis(P<0.05).Kaplan-Meier curve revealed that patients in the study group showed a trend of survival benefit.However,Log-rank test suggested that the difference between the two groups did not reach statistical significance(P>0.05).COX regression analysis indicated that vascular tumor thrombus was a risk factor of tumor-related death(P<0.05).Conclusion The adjuvant therapy with thymosin α1 combined with folfox regimen after trans-abdominal radical resection of RC can effectively activate the functions of dendritic cell,NK cell and T cell,increase the killing effect of tumor cell,reduce the loads of tumor-related factors,and thus help to reduce the recurrence and metastasis rate.

Aim To investigate the effect of Zhenwu decoction on inflammation,oxidative stress and apopto-sis of human glomerular epithelial cells(HGEC)in-duced by lipopolysaccharide(LPS)based on Nrf2/HO-1 signaling pathway,and to explore the underlying mechanism.Methods HGEC were treated with LPS(1.0 mg·L-1)for 24 h to construct an oxidative damage model.On this basis,2.5％,5％and 10％Zhenwu decoction-containing serum were added to the low,medium and high dose groups of Zhenwu decoc-tion,and a normal group was set up.The changes of cell activity were assessed by MTT method and LDH method.The contents of TNF-α,IL-6,IL-10,SOD,CAT,GSH-Px,ROS and MDA in each group were de-tected by ELISA.The apoptosis of each group was de-tected by flow cytometry.The mRNA and protein ex-pressions of Bax,Bcl-2,caspase-3,caspase-9 and Nrf2/HO-1 pathway were detected by RT-qPCR and Western blot,respectively.Results Compared to the normal group,the model group of HGEC exhibited increased levels of inflammatory cytokines,enhanced oxidative stress response and aggravated apoptosis;after inter-vention with various doses of Zhenwu decoction,the in-flammatory levels in HGEC were reduced,oxidative damage and apoptosis were effectively ameliorated,and the mRNA and protein expression levels of the Nrf2/HO-1 signaling pathway were upregulated.Conclu-sions Zhenwu decoction can protect HGEC from LPS-induced inflammation and oxidative damage and im-prove apoptosis.The mechanism may be related to the activation of Nrf2/HO-1 signaling pathway.

Objective To explore and analyze the clinical application effect of thymosin α1 combined with folfox regimen in the adjuvant treatment of patients after transabdominal radical resection of rectal cancer(RC).Methods A total of 102 patients with RC in the hospital were included from January 2020 to January 2024,and were randomly and evenly classified into two groups by adopting random number table method.The conventional group received folfox regimen after radical resection,whereas the study group was added with thymosin α1.The levels of tumor-related factors,changes of immune function indicators,treatment safety,recurrence and metastasis,and tumor-related mortality were observed in the two groups after treatment.Results Compared with before treatment,the levels of carcinoembryonic antigen(CEA),hypoxia-inducible factor-1α(HIF-1α),matrix metalloproteinase-9(MMP-9)and vascular endothelial growth factor(VEGF)in the two groups were significantly decreased,and the levels in the study group were significantly lower than those in the conventional group(P<0.05).After Bonferroni correction,CEA and MMP-9 were statistically different between groups(P<0.010).The CD83+,CD4+/CD8+and NK cell activity were significantly enhanced in the two groups compared to before treatment,and the above indicators were significantly higher in the study group(P<0.05).After Bonferroni correction,there were statistical differences in CD83+,CD4+/CD8+and NK cell activity between groups(P<0.010).In terms of treatment safety,the total incidence rate of toxic and side effects in the study group was 23.53%,which was significantly lower than 43.14%in the conventional group(P<0.05).Logistic regression(stepwise forward method)analysis showed that nerve invasion,vascular tumor thrombus and folfox regimen were risk factors of tumor recurrence and metastasis(P<0.05).Kaplan-Meier curve revealed that patients in the study group showed a trend of survival benefit.However,Log-rank test suggested that the difference between the two groups did not reach statistical significance(P>0.05).COX regression analysis indicated that vascular tumor thrombus was a risk factor of tumor-related death(P<0.05).Conclusion The adjuvant therapy with thymosin α1 combined with folfox regimen after trans-abdominal radical resection of RC can effectively activate the functions of dendritic cell,NK cell and T cell,increase the killing effect of tumor cell,reduce the loads of tumor-related factors,and thus help to reduce the recurrence and metastasis rate.

Aim To investigate the effect of Zhenwu decoction on inflammation,oxidative stress and apopto-sis of human glomerular epithelial cells(HGEC)in-duced by lipopolysaccharide(LPS)based on Nrf2/HO-1 signaling pathway,and to explore the underlying mechanism.Methods HGEC were treated with LPS(1.0 mg·L-1)for 24 h to construct an oxidative damage model.On this basis,2.5％,5％and 10％Zhenwu decoction-containing serum were added to the low,medium and high dose groups of Zhenwu decoc-tion,and a normal group was set up.The changes of cell activity were assessed by MTT method and LDH method.The contents of TNF-α,IL-6,IL-10,SOD,CAT,GSH-Px,ROS and MDA in each group were de-tected by ELISA.The apoptosis of each group was de-tected by flow cytometry.The mRNA and protein ex-pressions of Bax,Bcl-2,caspase-3,caspase-9 and Nrf2/HO-1 pathway were detected by RT-qPCR and Western blot,respectively.Results Compared to the normal group,the model group of HGEC exhibited increased levels of inflammatory cytokines,enhanced oxidative stress response and aggravated apoptosis;after inter-vention with various doses of Zhenwu decoction,the in-flammatory levels in HGEC were reduced,oxidative damage and apoptosis were effectively ameliorated,and the mRNA and protein expression levels of the Nrf2/HO-1 signaling pathway were upregulated.Conclu-sions Zhenwu decoction can protect HGEC from LPS-induced inflammation and oxidative damage and im-prove apoptosis.The mechanism may be related to the activation of Nrf2/HO-1 signaling pathway.

Objectives:To explore the value of non-invasive myocardial work combined with myocardial contrast echocardiography(MCE)in the early diagnosis of coronary artery disease and its efficacy in stratifying the severity of coronary vessel lesions.Methods:A total of 130 patients with suspected coronary artery disease admitted to the First Affiliated Hospital of Dalian Medical University from June 2024 to January 2025 were enrolled in this study.All patients underwent echocardiography and MCE after admission,and coronary angiography(CAG).Based on CAG results,patients were divided into non-CAD group(n=45,coronary artery stenosis<50%)and CAD group(n=85,coronary artery stenosis≥50%).Patients in CAD group were further divided into low-score CAD group(≤49 points,n=43)and high-score CAD group(>49 points,n=42)according to the median of Gensini score(49 points).Non-invasive MW indices and quantitative MCE parameters were assessed.A binary logistic regression model was used to construct a combined diagnostic model,and the value of each parameter in diagnosing CAD and evaluating the severity of coronary lesions was calculated.The receiver operating characteristic(ROC)curve of subjects was estimated,and the area under the curve(AUC)was calculated to evaluate its sensitivity and specificity for early diagnosis of coronary heart disease.Results:Compared with the non-CAD group,the global longitudinal strain,global work index(GWI),and global constructive work(GCW)in both low-score and high-score CAD groups were significantly lower(all P<0.05),and the global work efficiency in the high-score CAD group was significantly reduced(P<0.05).MCE indices in both low-score and high-score CAD groups were significantly lower than those in the non-CAD group(all P<0.05).The multivariate logistic stepwise regression analysis and ROC curve showed that GWI(OR=0.997,95%CI:0.995-0.999,P=0.003)and A value(representing the peak intensity of the curve,reflecting myocardial blood volume(OR=0.415,95%CI:0.246-0.698,P=0.001)were independent predictors of low-score CAD.The combined diagnostic sensitivity and specificity for low-score coronary artery disease were 72.1%and 88.9%respectively,with an AUC of 0.851.GCW(OR=0.997,95%CI:0.995-1.000,P=0.019)and β-value(OR=0.000,95%CI:0.000-0.003,P<0.001)were independent predictors of high-score CAD.The combined diagnostic sensitivity and specificity for high-score coronary artery disease were 88.1%and 88.9%respectively,with an AUC of 0.934.Conclusions:Both non-invasive myocardial work parameters and MCE parameters have high diagnostic efficacy for coronary artery lesions of various degrees.The combined application of the two methods significantly improves the accuracy of coronary artery disease diagnosis,with improved sensitivity and specificity than single technique.Our results provide a new non-invasive comprehensive diagnostic model for clinical early diagnosis and risk stratification of coronary artery disease.

Objective:To describes the probability and rate of native liver survival (NLS) in biliary atresia (BA) patients after Kasai portoenterostomy (KPE)over various time periods and analyzes the perioperative factors associated with liver transplantation or death.Methods:A retrospective case-summary.BA patients administrated at the Department of Fetal and Neonatal Surgery in Hunan Children′s Hospital between January 2015 and December 2021.Probability and rate of NLS were calculated by life table.Cox proportional hazards regression model and Logistic model was applied to explore the perioperative factors related to post-Kasai liver transplantation/death.Results:The median age at Kasai surgery was 62 days.The rate of jaundice clearance (JC) was 64.5% within 3 months after Kasai, and 58.3% of the patients had cholangitis.The probability of NLS reached its lowest point in the first 1 year after Kasai (76.2%) and ranged from 93.2% to 98.0% in years 2-8 after Kasai.The rates of NLS in 2 years, 5 years and 8 years were 71.1%, 62.8% and 56.0%, respectively.Cytomegalovirus (CMV) infection before or on the day of Kasai without antiviral treatment can increase the risk of liver transplantation or death[ HR(95% CI): 1.628 (1.081-2.452), P=0.020].Preoperative gamma-glutamyl transferase increased the risk of liver transplantation/death within 1 year after Kasai[ OR(95% CI): 1.001 (1.000-1.001), P=0.021], and early cholangitis was a risk factor for liver transplantation/death within 5 years after Kasai[ OR(95% CI): 1.934 (1.004-3.726), P=0.048].JC within 3 months post-KPE was a protective factor of NLS. Conclusions:The first year after Kasai was the highest risk period for liver transplantation/death, which should be the focus of follow-up management.JC within 3 months after surgery is the protective factor for overall NLS, 1-year NLS and 5-year NLS.